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Could Oral Insulin Be an Option Some Day?

Introduction

The role of insulin
Insulin’s job is to enable your body’s cells to absorb glucose (blood sugar) from your bloodstream. For people with type 1 diabetes, their body doesn’t make insulin. For people with type 2 diabetes, their body makes insulin, but their cells don’t respond to it. In both cases, levels of glucose in the blood get too high and can cause serious health problems.

Type 1 diabetes and many cases of type 2 diabetes are treated with insulin injections. For decades, these injections have been the only way to deliver insulin. You might wonder, why hasn’t an easier way to give insulin been developed?

The truth is, for more than 80 years, people have been trying to develop a form of insulin you can swallow. Pharmaceutical companies, government agencies, and universities have done extensive research in hopes of developing this “holy grail” of diabetes treatment. Where do we stand in the process?

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Appeal

Why oral insulin?

If you have any type of diabetes, keeping your blood sugar levels within your target range is vital. Not doing so raises your risk of serious health problems such as blindness, heart disease, kidney disease, and nerve damage.

To keep your blood sugar levels in a safe range, you have to follow your diabetes treatment plan. For many people with diabetes, this involves insulin injections. These injections can be inconvenient, they require training to self-administer, and they may need to be given several times per day. And, of course, they involve needles, which many people don’t like. For all of these reasons, many people don’t follow their diabetes treatment plan, which can lead to severe complications.

So, the idea that you could get your dose of insulin by simply swallowing a pill appeals to many people. Doctors believe that the ease of using a pill could make more people willing to start and maintain a successful insulin therapy routine. That could lead to better control of their diabetes.

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Physical benefits

How oral insulin would work

With injectable insulin, you use a needle to inject the insulin into the fatty tissue beneath your skin. From there, the insulin travels to your bloodstream. It goes into general circulation throughout your body and then travels to your liver.

High and low blood sugar
Insulin is used to prevent hyperglycemia, or high blood sugar levels, in people with diabetes. But if you have too much insulin in your body, too much sugar would move into your cells, leaving you with hypoglycemia. Managing diabetes is a balancing act of keeping your insulin and blood sugar levels in a healthy range.

Oral insulin, on the other hand, would move through your digestive system. It would be absorbed into your bloodstream through your intestines. From your intestines, it would move into your portal vein, a blood vessel that connects to your liver. Then the insulin would move directly into your liver, where glucose (blood sugar) is stored.

The process with oral insulin would more closely mimic the movement of natural insulin in your body than injectable insulin does. Moving insulin more quickly into your liver could help your body absorb and use glucose better. This could mean the insulin works faster. It could also mean a reduced risk of excess insulin in your blood, which could lead to a decreased risk of hypoglycemia (low blood sugar).

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Barriers

Why we don’t have oral insulin yet

We haven’t developed a type of oral insulin that can make it through the digestive system unharmed. The acids in your stomach break down oral insulin before it can get to your liver. That means it’s not effective by the time it reaches your liver.

Further, your body has trouble absorbing insulin from your intestines. The mucus layer in your intestines is thick, and studies have shown that only low levels of insulin pass through this lining and into your bloodstream. As a result, some researchers believe that high doses of insulin would be needed to be effective in managing diabetes.

Many clinical trials have been done on oral insulin, but no form of the treatment has made it through the trials successfully. The good news is, none of these trials has shown major health risks from oral insulin as compared to injectable insulin.

Diabetes prevalence
According to the Centers for Disease Control and Prevention, over 29 million Americans have diabetes. More than eight million of these people have not yet been diagnosed with the disease.

However, researchers are concerned that oral insulin could raise the risk of certain types of cancer. This is because large amounts of insulin would be needed to make it through the digestive system. Insulin is a growth-promoting substance, and large amounts of it could promote the growth of cancer cells. The bottom line, though, is that there's no established link between oral insulin and cancer.

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Other options

Current and future options

While researchers continue to strive for a pill form of insulin, another form is now available. Afrezza inhalation powder was approved by the Food and Drug Administration in 2014. Using an inhaler, you breathe in this drug at the start of a meal to help control spikes in blood sugar after your meal. The drug is absorbed into your bloodstream through the walls of your lungs. This method is not quite as desirable as a pill form, as it doesn’t go into your liver as quickly.

You can use Afrezza if you have type 1 or type 2 diabetes. However, with type 1, you must use injectable insulin as well.

Clinical studies are ongoing for other oral forms of insulin. For instance, a buccal spray is being studied. This drug would be sprayed into your mouth and absorbed into your bloodstream through the mucus membrane of your cheek.

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Takeaway

Talk with your doctor

Although an insulin pill isn’t yet available, it’s likely just a matter of time before medical science achieves this goal. In the meantime, be sure to work with your doctor to manage your diabetes with the treatments that are available.

If you have questions about oral insulin, your insulin treatment plan, or diabetes in general, talk to your doctor. They can work with you to create or manage a treatment plan that’s best for you. Questions you may have for your doctor include:

  • Would Afrezza be a helpful option for me?
  • Can I use a long-acting insulin so that I can give myself fewer injections?
  • Are there oral treatment options that would work just as well as insulin for me?
  • What other diabetes treatments do you think will be available in the near future?
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