On a busy league night in a Raytown, Mo., bowling alley, former auto worker Raymond Fowler keeps up his game playing alongside his wife and longtime teammates.
Fowler, who’s 67, stays busy in his retirement, but it’s not all fun and games. A few years ago, he was diagnosed with type 2 diabetes and made a lot of changes to his diet and exercise routine, which now includes four bowling sessions a week.
His condition was severe enough that his doctor said he needed insulin shots, and that’s one change Fowler has found troubling.
“The insulin — it would burn when you’d shoot yourself. It would just sting,” Fowler says. “And so after a while I went back and talked to my endocrinologist and told her, ‘I can’t keep doing this the rest of my life.’”
Insulin is a protein and can’t be taken orally in a pill because the body tries to digest it. Instead, many diabetics have to inject it with a syringe or a pen to maintain healthy blood sugar levels.
The routine can be especially complicated for type 1 diabetics, who have to test glucose levels and adjust insulin levels many times a day.
Simon Friedman, a professor at the University of Missouri-Kansas City School of Pharmacy, is trying to reduce the hassle, discomfort and pain these diabetics endure. He’s working on developing an alternate method of insulin delivery.
In lieu of needles, Friedman’s approach uses light to pierce the skin. Light, not diabetes, was the original focus of his work, but he realized it could have a diabetes application.
“It started with light,” he says. “We had quite a few years of developing methods to control other biological processes.”
On a recent afternoon in his lab, Friedman shows a rough prototype of an LED device that he says could be used to trigger the release of insulin. Friedman recently secured a grant worth nearly $1.5 million from the National Institutes of Health to pursue the project.
His notion is to create a single injection containing many individual insulin doses held together in an insoluble resin using “photocleavable linkers,” which are special molecular bonds that are especially sensitive to light.
“They’re molecules that do chemistry when you shine light on them,” Friedman says. “They’re kind of related to the molecules you might find in a recordable CD or a recordable DVD. They undergo photochemistry: chemistry bonds being made and broken using light.”
These light-sensitive bonds have been used in fields like genetics, but they’re new to pharmaceuticals.
Friedman envisions a method in which a patient injects the insulin mixture under the skin and straps an LED light atop it. When a glucose monitor indicates insulin is needed, the light would shine through the skin and break the link between the resin and the insulin, freeing the insulin to enter the bloodstream.
Unlike injections spread over the course of a day, this approach would adjust insulin levels constantly.
“That’s the nice thing about light,” Friedman says. “You can continuously vary light. Second by second you can adjust the intensity of light. You can change the duration of a light, and with that you can get continuously variable changes in release.”
Friedman hopes his method will reduce required injections to once every few days, once a week or possibly every few weeks.
The goal of reducing needle injections has spawned an entire field of research within diabetes care, and the value of this work extends beyond simply making injections less uncomfortable.
Mark Peyrot, a sociology professor at Loyola University Maryland in Baltimore who studies quality of life issues for diabetics, says that fewer painful injections can mean greater adherence to regimens and better overall health for patients.
That’s what happened when patients began using insulin pens, which were introduced as a less painful alternative to syringes about 30 years ago.
“They tend to find it more convenient, so they are more comfortable in taking their medication, which may make it somewhat more likely or easier for them to begin taking insulin or to take more shots if they have to take shots in the day,” Peyrot says.
To get patients on board with new insulin technology, however, it has to be simple and streamlined, unlike some recent delivery systems like insulin pumps and inhalable insulin, which aren’t as widely used.
“Is it complicated? Is it easy to use? Because that’s going to be one of the main factors that prevents people from making that transition,” Peyrot says.
Friedman’s new insulin system may be promising, but Peyrot sees a couple of wrinkles that may need ironing out.
The light-and-insulin method is meant to work hand-in-hand with a constant glucose monitoring system, and that technology isn’t quite ready for prime time.
Even if it were, it probably would have to be worn, along with the light emitter itself, on the outside of the body.
“Some people have major concerns about this,” Peyrot says. “Not medical concerns, but cosmetic concerns. Concerns about body image and so forth. Other people find it difficult to actually wear devices on their skin.”
Friedman acknowledges there’s still plenty of work to be done on the technology. Early tests using animals have been encouraging, but he’s planning to spend the next few years refining it to find the optimal insulin mixture and light usage.
Whatever form it takes, insulin delivery without regular injections can’t come soon enough, as far as Raymond Fowler is concerned.
Exercise, diet and oral medications have allowed him to stop taking insulin, but his blood sugar is creeping up again, and he’s now facing the possibility of having to resume injections.
He confesses he’s been putting off some doctor’s visits.
“That’s the reason why at first I didn’t want to go to see her, because I knew she’d put me back on insulin,” he says. “And I just couldn’t fool with them needles no more.”