Since insulin's crucial discovery nearly a century ago, countless diabetes patients have had to inject themselves with the life-saving medicine.
Now Indian scientists have reported a new development toward a long-sought insulin pill that could save millions the pain of daily shots.
Published in the American Chemical Society journal, the advance could someday not only eliminate the "ouch" factor but also get needle-wary — and weary — patients to take their medicine when they should.
For years, researchers have sought a way to transform delivery of this therapy from a shot to a pill, but it has been a challenge.
The body's digestive enzymes that are so good at breaking down food also break down insulin before it can get to work.
In addition, insulin doesn't get easily absorbed through the gut into the bloodstream.
To overcome these hurdles, Sanyog Jain from India's National Institute of Pharmaceutical Education and Research combined two approaches to shield insulin from the digestive enzymes and then get it into the blood.
They packaged insulin in tiny sacs made of lipids, or fats called liposomes, which are already used in some treatments. Then, they wrapped the liposomes in layers of protective molecules called polyelectrolytes.
To help these "layersomes" get absorbed into the bloodstream, they attached folic acid, a kind of vitamin B that has been shown to help transport liposomes across the intestinal wall into the blood.
In rats, the delivery system lowered blood glucose levels almost as much as injected insulin, though the effects of the "layersomes" lasted longer than that of injected insulin.
Diabetes inhibits the production or use of insulin, which is a hormone that helps blood glucose or blood sugar become absorbed into cells and give them energy.
Diabetes is one of India's biggest health challenges. By 2030, India's diabetes burden is expected to cross the 100 million mark, against 87 million estimated earlier.
Type 1 diabetes occurs when the body doesn't make enough insulin, and type 2 diabetes occurs when the body doesn't make or use insulin very well, causing glucose to remain in the blood, which can lead to serious problems.
Libby Dowling, care advisor at Diabetes UK, said "Oral insulin could make a big difference to the lives of people with diabetes. Children, elderly people and those with a phobia of needles would benefit particularly if and when insulin capsules become a safe and effective treatment for the condition. Although more research is needed, Diabetes UK would very much like to see insulin capsules one day become a reality."
She added, "Many people with Type 2 diabetes take diabetes tablets. They are not the same as insulin. As yet insulin cannot be taken in tablet form because it would be broken down in the stomach before it could work. Diabetes tablets work in different ways to lower blood glucose levels - for example by stimulating the pancreas to produce more insulin, or by helping the body to use the insulin that it does produce more effectively"
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