Why you should care

Smart insulin could alleviate the anxiety of managing one of the most common chronic diseases.

Ever wish your head were a calculator? What a gift for the math-challenged, and what a convenience for CPAs. Three of the Schuhmacher brothers, in Indiana, kind of live this dream, but for a grave reason: Type 1 diabetes. All day long they run calculations through their minds — along with pricking their fingertips — to stay on top of their blood-insulin levels. Their mother, Meri, takes over at night, tiptoeing into their bedrooms to prick their fingers as they sleep. “There are no days off,” she says.

Roughly 3 million other Americans endure this kind of medieval tedium every day. And it’s not like these diabetes sufferers have any choice in the matter: The complicated chain reaction that goes down in a diabetic pancreas can lead to blindness, nerve damage or comas. And even with care and vigilance, mistakes with catastrophic consequences happen: New Jersey-based blogger Scott Benner recalls when his daughter, Arden, suffered a seizure after he accidentally gave her too much insulin. All of which is why some new but little-noticed research advances could mean a light at the end of that finger-pricking tunnel. And, yes, we’re about to use the most ubiquitous tech term of them all: “smart.”

MIT engineers have designed a smart insulin that stays in the bloodstream for at least 10 hours.

Here’s how: Scientists are toiling away on a number of promising treatments that focus on finally giving the Meris of the world a day off. It starts with MIT engineers, who have designed a smart insulin that stays in the bloodstream for at least 10 hours in mice, and it spans approaches from the tried-and-true vaccine angle to the downright sci-fi: a man-made pancreas. San Diego-based company ViaCyte recently began clinical trials of such an organ, concocted of immature pancreas cells and plastic mesh. That little bundle of joy is then inserted under the skin. “The dream would be … to really control blood sugar in humans without needing many, many injections and measurements,” says Daniel Anderson, an applied biology professor at MIT who helped lead the smart-insulin study, detailed in the Proceedings of the National Academy of Sciences.

Diabetes, of course, is one of those heavily discussed diseases, and only increasingly so these days as it gets tied more and more to obesity and sedentary lifestyles. But even though we’re drowning in modernity, so little of modern technology comes into play with diabetes, a surprisingly common problem with some other well-known ills. Think broken bones, which are cured not with high-powered lasers but rather with plaster, crutches and time. Or sunburn — you fry, you’re toast. Meanwhile, proton radiation, courtesy of three, and only three, $100 million machines, treats tumors, such as those in the brain or prostate, in a way that evokes Marvel Comics. It’s just one of many new tech-savvy medical solutions that seem to be hitting all sorts of ailments — besides diabetes.

A hundred years ago, science discovered that insulin could treat diabetes, and in the century since, blood-glucose monitoring and insulin therapy have reigned, creating a sort of vintage existence for patient and family alike. The most recent major innovation? Insulin pumps and the glucose meters that work with a finger prick of blood … which arrived in the 1970s. But it’s hard for diabetes sufferers to know exactly how much food or insulin they need. Enter that smart insulin, which turns on only when blood glucose levels spike too high.

At Harvard’s Stem Cell Institute, co-director Doug Melton last year reported generating hundreds of millions of cells in the pancreas from human embryonic stem cells. Meanwhile, Michael Shamblott, a chair of pediatrics at the University of South Florida, led the discovery that pancreatic cells responsible for making digestive enzymes express NGN3, the “master gene” that drives the development of crucial cells. The drug he envisions would tell the pancreas “it’s OK to make more NGN3-positive cells,” he says. But he notes that scientists still need to develop drugs to block the immune system from destroying the replenished cells.

To be sure, much of the technology has yet to be tested in humans and could take several years to reach the clinic. Meri remains wary. With every son they diagnosed, doctors assured her a cure lay five years away. After her youngest son’s diagnosis, she was fed up. “You’ve told everyone that for years,” she seethed. And even if such technology does reach the clinic, it could take years for price points to reach an affordable level. As it is, insurance coverage of glucose meters varies. Benner says he’s lucky that his company’s insurance plan covers Arden’s. Even if Arden has kids of her own by the time she sees these new therapies, he’s hopeful. “I’m really enthusiastic about some of this stuff,” he says.

An earlier version of this story misstated what signals smart insulin to activate.

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