Last month, we held a symposium on novel insulins, where experts from around the world met virtually to discuss their ideas for how to develop the next generation of insulins. Their fascinating discussion will be published in a scientific review paper later this year. In the meantime, here is a preview of five of the most exciting ideas that were discussed at the symposium.

2. Oral insulin pill inspired by tortoises

The problem with taking insulin orally in a pill also partially comes down to its size. If you were to swallow a pill of insulin, it would first break down in your stomach, meaning it couldn’t work properly, and even then, it would still be too big to pass through your intestines. But world-renowned scientist Professor Robert Langer at Massachusetts Institute of Technology (MIT) has developed an ingenious pill that protects insulin and then fires it into the stomach lining.

3. A weekly insulin could be coming

People with type 1 currently take a type of slow-acting insulin, known as basal insulin, once or twice a day to control blood sugar outside of eating. Researchers are developing a new generation of insulins that can work for even longer, reducing the number of injections you need. It may seem counterintuitive, but by editing insulin to make it less effective at clearing glucose, researchers can make it work for longer. This reduced function means it can stay in the body without causing hypoglycaemia.

Novo Nordisk have used this principle to create an insulin called insulin isodec, which has had very promising results in clinical trials. The company has now applied to the US Food and Drug Administration (FDA) for regulatory approval, meaning weekly basal insulin injections could soon become a reality for people with diabetes.

4. Ways to make insulin respond to glucose

Scientists specialising in different disciplines from chemistry to bioengineering have inventive ideas about how to create glucose-responsive insulins, also known as smart insulins. An interesting idea is to create a mixture of insulin and a chemical that can sense glucose, with a large molecule to keep them together.

A team led by Professor Matthew Webber at the University of Notre Dame has developed such a mixture. The insulin mixture is an insoluble blob at a neutral pH, which means not acidic or alkaline. Then, when glucose levels rise, the pH becomes more acidic and the mixture dissolves, releasing the insulin so that it can bind to glucose. Their tests on animals have shown that a single dose of their smart insulin mixture can keep glucose levels stable for up to five days in mice and up to a week in pigs.

5. Computer models to streamline research

Treatments must be tested in animals before they can enter clinical trials with people. But lots of drugs that are effective in animals turn out not to work in humans. Professor Michael Strano and his team at MIT have developed a sophisticated computer model of the glucose control system in animals and humans, which can predict how the body will respond to different treatments. The team created the simulation using a combination of maths, biochemistry and extensive data collection from people with type 1.

Researchers can plug their drug designs into the computer model to predict whether it will work or not and edit their designs accordingly. This tool is especially useful for glucose-responsive ‘smart’ insulins because scientists all over the world are experimenting with a range of different approaches to develop them. The simulator will streamline the research process by allowing researchers to only invest time and energy in their ideas that have the best chance of success. It will save crucial time, money and effort in the research and development stage and ensure only the insulins (and other therapies for type 1) with the most potential progress to clinical trials.

Bonus: glucose-responsive glucagon

We can apply all of these ideas for creating glucose-responsive insulin to the hormone glucagon, which has the opposite effect to insulin. Glucagon stimulates glucose production and release from where it is stored in the liver, which is why it is a treatment for severe hypoglycaemia.

Type 1 Diabetes Grand Challenge offers hope for novel insulins

The £15 million set aside by the Type 1 Diabetes Grand Challenge to tackle the challenge of novel insulins will expand upon this exciting research to bring these innovative ideas closer to reality. From hormones that can respond to varying glucose levels, to fast- and long-acting insulin, to easier ways to take insulin without injections, novel insulins are coming, and the Grand Challenge will get us there faster.