Insulins today are more refined and much purer than they were in the past. We are now able to make biogenetic human insulin (growing other cells, such as yeast or certain bacterial cells and genetically engineering them to make human insulin). However, pure human insulin is shorter acting than less pure pork or beef insulin so more injections a day will be required to provide optimal 24-hour control.

New insulins called “designer” insulins have been and are being developed. Humalog (Lispro) insulin became available in August 1996 and is currently used in a variety of insulin regimens. This insulin allows much greater flexibility in designing a regimen specific to each individual’s needs. Humalog (Lispro) insulin can be used alone or mixed with NPH, Lente, Ultralente, or Regular in almost any combination. We most commonly use it for a three or four-dose insulin schedule as follows: (1) Humalog before each meal and NPH or Lente at bedtime, (2) Humalog and NPH for breakfast, Humalog for lunch and supper, and NPH or Lente at bedtime, (3) Humalog and NPH at breakfast, Humalog at supper, and NPH or Lente at bedtime and (4) Humalog at meals and Ultralente once or twice a day. In addition, we sometimes combine regular with one of the Humalog doses such as the supper dose. We have used other schedules as well such as NPH at noon when breakfast and lunch are close together and lunch and supper are too far apart for the Humalog to cover. In brief, Humalog is versatile insulin that can be used in combinations to tailor the diabetes to the person and their needs rather than make the person change their life to fit the insulin.

The Novo Nordisk company will soon have a rapid acting insulin similar to Humalog, and the Hoerscht Marion company (as well as the Eli Lilly and Novo Nordisk companies) are developing insulin analogs that are long acting and may soon supplant Ultralente as a 24-hour basal insulin. Insulin therapy should therefore get much easier and more flexible in order to better tailor the treatment to each individual’s needs.

Bloodless meters that measure blood glucose without pricking the finger are an ultimate dream. At Kansas State University, a similar technology was developed for the food industry using a laser beam to measure the sugar content of fruit and other foods without breaking the skin of the food. Unfortunately, this technology is more difficult for use in humans. Skin thickness varies from person to person, and temperature varies the accuracy. This technology, dubbed “The Dream Beam,” is still possible, but it is still some time away before it is cheap enough or accurate enough to be of practical use in the future.

New ways of administering insulin are now available or under study. Injectors, jet injectors, and so forth have been improved recently and are becoming cheaper. Disposable syringes with smaller needles that are silicon coated for easier and more painless entry are now available and make giving insulin essentially painless if given by the right technique. None the less, many people dream of another way to give insulin. Three ways being tried are by the nasal route, by inhalation into the lungs, and through the skin. The nasal route has been tried for some time, especially in Europe, but has many limitations such as irritation of the nasal membranes, swelling, stuffy nose, and compromised availability when you have a cold or allergy. Insulin given through the skin is still an idea without much research to support it. Insulin is too large a molecule to get through the skin easily and may not be practical until new methodologies are available, but it still remains a possibility. Inhaled insulin is currently under testing on humans. The insulin is inhaled like the asthma meds using a similar inhaler. The insulin is a powder that is inhaled into the lungs that are endowed with many blood vessels to absorb the insulin. The method works, but the proper dose schedule and long term effects are not known. Only short-acting insulin can be given this way, so one or two shots a day of intermediate or long-acting insulin will still have to be given. The current estimate is that the tests will be complete in about the year 2003 or 2004.

Some exciting new therapies have been developed for Type 2 diabetes. New oral hypoglycemic agents are being tested, as are combinations of different oral agents and of oral agents and insulin. New dietary treatment is being developed for weight loss and blood-sugar control. There are new findings about the way insulin works and why the body’s system goes wrong. Scientists are currently making good progress in learning about Type 2 diabetes, and we are very optimistic about the future. Metformin, acarbose, and trogitazone are the recent results of this research. Other new drugs will soon be available. There are at least two other drugs similar to acarbose, but with less side effects, and a new glitizone drug, called rosiglidtizone, with less liver toxicity will be available very soon. Others are in the research pipeline. Look for new and better ways to treat your disease in the near future.

If you have an idea for a new diabetes treatment, mention it to your family physician. If it seems in any way possible, contact your diabetes association for the name of a researcher in your area. Write up your idea. If you have difficulty writing, describe it into a tape recorder or in a face-to-face discussion. Get your idea to that researcher. Don’t be afraid of being turned down. Perhaps your idea has already been tried. But again, perhaps no one has tried what you have thought up in exactly the same way. If you have the resources, find out ahead of time whether your idea has been tried before. If not, most researchers who know about diabetes will know whether the information you discuss is new or old.

Education for you and for professionals helps to develop new ideas. The American Diabetes Association has developed a set of medical standards to guide health professionals in diabetes management.

As they learn about these standards, they may question them or determine that they would be best carried out another way. In other words, the health professionals will stimulate thinking in regard to what is being done, aid in upgrading what is done, and stimulate ideas for doing things better.

The effort to do things better means that there are people who care, and that change is possible for the person who has the disease. Is it best to learn what causes diabetes, how best to manage it, or how to cure it? For those who have the disease, the cure is the focus; for those with a strong family history of diabetes, prevention is the focus. For ongoing care, ways to treat diabetes are the center of attention. Scientists therefore approach diabetes from all these angles.

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