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Marta Dopita
Professor Jennifer Courtney
English 2010
September 20 2016
A Smart Look Into Diabetes
Diabetes has become an epidemic in developing countries and is a predominant disease in
our country. The American Diabetes Association (ADA) found that this disease affects
approximately 29.1 million people in the United States, 27% of which are undiagnosed. There
are three main types of diabetes that are insulin dependent, Type 1(juvenile diabetes), Type 2 (on
the rise in children but mostly affects middle-aged overweight or inactive adults), and
Gestational diabetes (affecting pregnant obese or overweight women). Although the number of
people with diabetes is increasing, recently there has been a discovery in insulin treatment that
could change the face of diabetes across the country and the world ("Statistics About Diabetes).
Before we can conclude that the new findings are truly groundbreaking, we must
understand what diabetes does to the body and how it can be treated. According to the U.S
National Library of Medicine (NIDDK), Type 1, also called juvenile diabetes, usually first
appears in adolescence and occurs when the bodys immune system attacks insulin cells, making
it impossible for the body to produce anymore. Type 2 diabetes; also called adult-onset diabetes,
because it usually occurs in middle-aged adults but is on the rise in children ensues,
[W]hen fat, muscle, and liver cells do not use insulin to carry glucose into the bodys
cells to use for energy. As a result, the body needs more insulin to help glucose enter
cells. At first, the pancreas keeps up with the added demand by making more insulin.

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Over time, the pancreas doesnt make enough insulin when blood sugar levels
increase, such as after meals. ("Types of Diabetes | NIDDK")
When this occurs, the condition needs to be treated. Typically Type 2 diabetes affects people
who are overweight or inactive. The third main type of diabetes is called Gestational Diabetes
and it mostly affects overweight or obese pregnant women and results in the lack of production
of enough insulin by the pancreas.
Insulin injections are an important component in treating all three types of diabetes and
traditional insulin (insulin that is most commonly used) is completely regulated by the diabetic.
Chris Biela mentions in Development of smart insulin to change lives of diabetes patients,
that even when all necessary components are taken into consideration (e.g. carbohydrate intake,
exercise, alcohol, absorption rate, etc.) and a certain amount of insulin is injected, sometimes
forgetting a component, underestimating or over estimating, may result in an insulin overdose.
Insulin overdoses are not as uncommon as one would think, an overdose can result in a
hypoglycemic episode and it can be fatal (83). As a result, insulin dependency requires an
extreme dedication to the disease, specifically for people with Type 1 diabetes, because for them
it is a life-long disease.
Many of us face multiple obstacles in our lives that we find difficult, but imagine facing
these obstacles and adding on the rigors of a disease that, if not treated daily and correctly can
kill you in an instant. In the graph below (Figure 1), is demonstrated how often a person with
diabetes must follow through with treatment in one day. This persons glucose was being
measured with a blood glucose monitoring system that is attached to the body and it checks
blood sugar levels 300 times a day. Each line represents a different day and the 180 line
represents the high blood glucose danger zone. Typical meal times are, when the glucose level

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spikes and where glucose levels decline are where this person took insulin. This figure also
demonstrates how difficult it can be to stay consistent.

Figure 1,Blumer, Ian M.D.; Ourdiabetes.com

According to Nobelprize.org, the insulin we use today began with the first person to
discover insulin cells that are produced by the human body and that was Paul Langerhans, a
German medical student in 1869. In 1889 Oskar Minkowsi and Joseph von Mering also in
Germany, discovered the two main functions of the pancreas, to produce digestive juices [and]
to produce a substance that regulates the sugar glucose ("The Discovery of Insulin"). In the
1920s Dr. Frederick Banting and his medical assistant Charles Best, discovered that animal
insulin from cattle can be injected into the human body, we now use cattle and pig insulin
because this insulin is the most effective and in the largest supply (Lawrence).
Banting and Professor Macleod (the man who funded Bantings research) received a
Nobel Prize in 1923 in Physiology or Medicine. As the Official Web Site of the Nobel Prize

states, Although insulin doesnt cure diabetes, its one of the biggest discoveries in medicine

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("The Discovery of Insulin"). Insulin has saved the lives of many and it has provided diabetics
with a life as close to normal as it can get.
Another type of insulin that is commonly used is human insulin, according to the
National Library of Medicine; this insulin is produced with the human gene, with bacteria and
yeast. The bacteria and yeast are reprogrammed to create human insulin instead of the proteins
they would usually create ("How Did They Make Insulin from Recombinant DNA?").
When we eat, our blood sugar/glucose levels rise, so our pancreas releases insulin cells
into our blood to lower blood sugar. Since people with diabetes do not get the correct response
from their pancreas they have to inject themselves with insulin to prevent their body from going
into hypoglycemic shock. While there are insulin overdoses, there are also cases where not
enough insulin is used, that can also be fatal. When it comes to insulin injections, it is mostly just
experienced guesswork, but even people who have had diabetes their entire lives sometimes
over/underestimate their dosage. In response to these complications, Danny Chou and his team
of researchers described this guesswork in their publication Glucose-responsive insulin activity
by covalent modification with aliphatic phenyloboronic acid conjugates,
Even with perfect use, traditional insulin therapy fails to match the kinetics of
normal insulin signaling. Even small improvements in glycemic control over time
have the potential to reduce the frequency of serious complications, including
blindness, cardiovascular disease, stroke, non-healing wounds and cancer.
Glucose-responsive insulin, with bioactivity that is regulated by glucose levels in
the body, could improve glycemic control (Chou et al.).
Researchers have been working for many years to find insulin that can regulate itself to help ease
the lives of millions of people with diabetes. We may bare witness to this in the next few years.

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In February of 2015, Danny Chou and a team of researchers between the University of
Utah and MIT (Massachusetts Institute of Technology) published their research on smart
insulin. For years, researchers have been working tirelessly to develop self-regulating insulin.
Now, it has become a reality. Danny Chou and his team modified and created insulin then tested
it on diabetic mice. They found that Ins-PBA-F, restores blood glucose levels following a
glucose challengefaster than both standard insulin and a clinically used long-lasting insulin
derivative(Chou et al.) The significance of this insulin is that it can stay in the body from 14-24
hours, with only one injection daily. Whereas, traditional insulin that lasts in the body for up to 6
hours and must be constantly regulated throughout the day as shown in figure 1. (Chou et al.)
Below you can see the findings of this Ins-PBA-F in figure 1.
This new insulin will respond to the persons blood glucose levels just like natural insulin
does for non-diabetics. This product can also completely eliminate overdoses and/or eradicate
blood glucose highs. This smart insulin or Ins-PBA-F, is a massive leap forward in the world
of diabetes. But, it is not the only recent finding that could soon be changing the lives of
diabetics everywhere. While smart insulin is synthetic, natural smart insulin was discovered
in the venom of cone snails.
Helena Safavi-Hemami from the University of Utah and a group of researchers from New
York City, Denmark and Australia determined that only 5-6 species of cone snails use insulin as
venom for their prey and only one of those species, Conus geographus has, [t]he ability to
effectively lower blood glucosesimilar to human insulin(Safavi-Hemami et al.). This
naturally occurring smart insulin could replace or coincide with the smart insulin developed

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by Danny Chou and his team. These findings were published in February of 2015 just a few days
before Danny Chous teams findings.
Although, Chous smart insulin is in fact, groundbreaking, it is rumored that it is not
the first glucose-reactive insulin to come to light ("Merck's R&D Journey"). Merck, a big
pharmaceutical company, is said to have started human trials on their own smart insulin in
2015 (Hoskins). Meanwhile, Chous insulin may not start human trials until next year. Diabetes
is a meticulous disease and it is very difficult to maintain, these breakthroughs can improve the
daily lives of millions of people affected by diabetes.

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WORKS CITED
Biela, Chris. "Development of smart Insulin to Change Lives of Diabetes Patients." Journal of
Renal Nursing, vol. 7, no. 2 (2015) pp. 83. Web. 15 Sept. 2016.
Chou, Danny Hung-Chieh, Matthew J. Webber, Benjamin C. Tang, Amy B. Lin, Lavanya S.
Thapa, David Deng, Jonathan V. Truong, Abel B. Cortinas, Robert Langer, and Daniel G.
Anderson. "Glucose-responsive Insulin Activity by Covalent Modification with Aliphatic
Phenylboronic Acid Conjugates." Proceedings of the National Academy of Sciences Proc
Natl Acad Sci USA vol.112, no.8 (2015) pp. 2401-406. Web. 15 Sept. 2016.
Figure 1. Blumer, Ian M.D.; Ourdiabetes.com; Web. 27 Sept. 2016.
Hoskins, M. "More Brains Exploring the Possibility of 'Smart' Insulin." More Brains Exploring
Smart Insulin. Diabetes Mine, 25 Feb. 2015. Web. 21 Sept. 2016.
How Did They Make Insulin from Recombinant DNA?" U.S National Library of Medicine.
U.S. National Library of Medicine, Web. 21 Sept. 2016.
Snail Insulin Faster Than Human Insulin | GEN News Highlights | GEN." GEN. GEN, 19 Sept.
2016. Web. 21 Sept. 2016.
Lawrence, Dr. "The Great Debate: Natural Animal or Artificial 'Human' Insulin?" IDDT. Web.
21 Sept. 2016.
Merck's R&D Journey." Merck.com. Web. 21 Sept. 2016.
Safavi-Hemami, Helena, Joanna Gajewiak, Santhosh Karanth, Samuel D. Robinson, Beatrix
Ueberheide, Adam D. Douglass, Amnon Schlegel, Julita S. Imperial, Maren Watkins,
Pradip K. Bandyopadhyay, Mark Yandell, Qing Li, Anthony W. Purcell, Raymond S.
Norton, Lars Ellgaard, and Baldomero M. Olivera. "Specialized Insulin Is Used for
Chemical Warfare by Fish-hunting Cone Snails." Proceedings of the National Academy

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of Sciences Proc Natl Acad Sci USA vol. 112, no.6 (2015) pp. 1743-748. Web. 15 Sept.
2016.
Statistics About Diabetes." American Diabetes Association. 1 Apr. 2016. Web. 21 Sept. 2016.
The Discovery of Insulin". Nobelprize.org. Nobel Media AB 2014. Web. 21 Sep 2016.
Types of Diabetes | NIDDK." U.S National Library of Medicine. U.S. National Library of
Medicine, Feb. 2014. Web. 21 Sept. 2016.