# Insulin injections for diabetics just once monthly with new 'jelly' substance



## Northerner (Jan 29, 2013)

Diabetics could be given monthly injections of insulin instead of several daily after scientists devised a slow release 'jelly', it has emerged.

Early stage tests suggest the new substance could dramatically cut the number of injections type 2 diabetics need, researchers at Duke University in America said.

Traditional insulin needs to be injected frequently to keep blood sugar levels stable but even then it creates 'peaks and troughs' as the body processes it quickly which can cause complications.
Scientists have been working to find a way to deliver the drug in an even way over time.

Engineers have created a liquid that turns to jelly once injected under the skin and leaches out its active ingredient gradually.
Tests on mice showed it kept blood sugar levels stable for five days, 120 times longer than normal.

http://www.telegraph.co.uk/health/h...ly-with-new-jelly-substance-being-tested.html

Rather misleading, as only useful as a basal I would have thought, and therefore not replacing 'several' injections a day! Heaven forfend you should inject too much and spend a month feeding the insulin!


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## DeusXM (Jan 29, 2013)

It's also duff logic. Basals aren't flat for most people, which is why people tend to use Levemir as a split foundation. If you've got a basal that fluctuates (and guess what, you do even if you don't realise it!) then something that offers a steady, constant flow of insulin over 5 days is next to useless.

Hey-ho, yet another 'great' idea aimed at reducing the number of injections we have to do, as if that's the problem with diabetes.


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## Vicsetter (Jan 29, 2013)

Not sure of your logic Deus. I inject a 50/60 split of levemir, if I could inject once a week to cover the 50/50 requirement then at most I would have 1 injection a day.  The usual reason to split your basal is because it doesn't last 24 hours, I inject more in the evening so that it covers my main meal and to avoid the dawn effect.
However I'm more concerned about the quantities involved, to cover 5 days I would need 500 units of levemir plus whatever makes the jelly, thats a big lump under the skin


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## DeusXM (Jan 29, 2013)

But Vicsetter, why is it then that almost every pump user has variable basal rates throughout the day? 

I know a lot of people take Levemir twice a day because it doesn't last the full 12 hours but how many times on this board has it also been said this is a good thing because it allows you to have a more tailored basal regime? You yourself say you change how yours is split to cover your meal and Dawn phenomenon. Therefore with this product, your control would be substantially worse. It's another shinier bucket - except this one's just bigger and has a hole in the side.

Theoretically yes, if you're happy with poorer control if the benefit is fewer injections, then the jelly's fine. I'm just not convinced that's a good trade-off.


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## Northerner (Jan 29, 2013)

DeusXM said:


> But Vicsetter, why is it then that almost every pump user has variable basal rates throughout the day?
> 
> I know a lot of people take Levemir twice a day because it doesn't last the full 12 hours but how many times on this board has it also been said this is a good thing because it allows you to have a more tailored basal regime? You yourself say you change how yours is split to cover your meal and Dawn phenomenon. Therefore with this product, your control would be substantially worse. It's another shinier bucket - except this one's just bigger and has a hole in the side.
> 
> Theoretically yes, if you're happy with poorer control if the benefit is fewer injections, then the jelly's fine. I'm just not convinced that's a good trade-off.



I think you need to bear in mind that not everyone (in fact, I imagine the vast majority) of insulin users would suffer a degradation, rather than an improvement, in control from a flat basal, given that most are not fine-tuning control, but barely managing it.


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## Dory (Jan 29, 2013)

and don't forget guys, this test refers to T2 diabetics, whose basal rates may possibly differ to T1s anyway (which is I'm guessing where you are getting your frame of reference from).


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## DeusXM (Jan 29, 2013)

> given that most are not fine-tuning control, but barely managing it.



But in that case, all the gel is doing is giving them yet another tool to use improperly. As I understand it, the gel simply replaces insulin injections, it doesn't offer any additional functionality. Therefore a T2 who isn't matching their basal correctly with injections will also fail to match it correctly with this gel, but they'll just have fewer injections. I suppose that will be of benefit to those T2s who are either deliberately non-compliant because they have injection issues or those who suffer poor memory and this can't always remember to do their jab. Although in the latter category, doing something once every five days is even less likely to be habit-forming than doing something once every day.


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## Northerner (Jan 29, 2013)

DeusXM said:


> But in that case, all the gel is doing is giving them yet another tool to use improperly. As I understand it, the gel simply replaces insulin injections, it doesn't offer any additional functionality. Therefore a T2 who isn't matching their basal correctly with injections will also fail to match it correctly with this gel, but they'll just have fewer injections. I suppose that will be of benefit to those T2s who are either deliberately non-compliant because they have injection issues or those who suffer poor memory and this can't always remember to do their jab. Although in the latter category, doing something once every five days is even less likely to be habit-forming than doing something once every day.



Maybe, but it would be helpful for those in, for example, care homes, or with physical restrictions, where their medication is dependant on someone else providing it. And I wouldn't underestimate the numbers of non-compliant or needle-phobic people who would be much better off with a once-monthly injection.


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## Vicsetter (Jan 29, 2013)

DeusXM said:


> But in that case, all the gel is doing is giving them yet another tool to use improperly. As I understand it, the gel simply replaces insulin injections, it doesn't offer any additional functionality. Therefore a T2 who isn't matching their basal correctly with injections will also fail to match it correctly with this gel, but they'll just have fewer injections. I suppose that will be of benefit to those T2s who are either deliberately non-compliant because they have injection issues or those who suffer poor memory and this can't always remember to do their jab. Although in the latter category, doing something once every five days is even less likely to be habit-forming than doing something once every day.



Why do you assume the negative?  Have you evidence that the majority of T2s manage their basal dosage incorrectly?  Do you assume that the majority of T2s are rebellious and senile? The added functionality is injecting every 5 days and not every day - got to be worth some extra quality of life.


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## Copepod (Jan 29, 2013)

Completely agree with you, Vicsetter, Northerner & Dory - the new susbstance is aimed at T2Ds, for them and their health care professionals to consider / decide, taking account of their needs.


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## DeusXM (Jan 30, 2013)

> Have you evidence that the majority of T2s manage their basal dosage incorrectly?



Oh, I see. Northerner says "most are not fine-tuning control, but barely managing it" but *I'm* apparently the negative one. All I was doing was reiterate his point, take it up with him if it's an issue for you. 



> Do you assume that the majority of T2s are rebellious and senile?



Please show me WHERE I suggested this. It was Northerner who brought up care homes and the idea that you shouldn't underestimate the number of people who are non-compliant, not me.  All I said was those T2s who weren't compliant or had poor memory (which doesn't actually suggest senility - look, if I had to do an injection every five days instead of every day, I'd probably forget to do it too!) could benefit from this. Given that the central thrust of my point is that this product is of LIMITED benefit, it would therefore follow that my assumption is there are LIMITED number of T2s who are, as you put it, 'rebellious and senile'. 



> The added functionality is injecting every 5 days and not every day - got to be worth some extra quality of life.



And if we assume that having to do an injection does impact on your quality of life, then I suppose yes, this is a benefit. I suspect though that the majority of people who inject insulin do not actually find insulin injections to have a serious impact on the quality of their life. I suspect in fact it's the constant having to manually manage their blood sugar levels and all the rigmarole that entails.


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## Northerner (Jan 30, 2013)

Yes, to clarify, I was thinking of the large number of Type2s who would get improved control and other benefts which, although they may or may not be a small percentage of all Type2s are certainly a significant number, especially if you put it in a global context with 300m+ diabetics.


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