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Could Oral Insulin Be an Option Som

Written by Kimberly Wonderly
Medically Reviewed by Zara Risoldi Cochrane, PharmD, MS, FASCP on 21 December 2016

Introduction Appeal Physical benefits Barriers

Part 1 of 6

Introduction
Type 1 diabetes and many cases of
type 2 diabetes are treated with
insulin injections. For decades, these
injections have been the only way to
deliver insulin. You might wonder, why
hasnt an easier way to give insulin
been developed?
The truth is, for more than 80 years,
people have been trying to develop a
form of insulin you can swallow.
Pharmaceutical companies,
government agencies, and universities
have done extensive research in hopes of developing this holy grail of
diabetes treatment. Where do we stand in the process?
The role of insulin
Insulins job is to enable your bodys
cells to absorb glucose (blood sugar)
from your bloodstream. For people
with type 1 diabetes, their body
doesnt make insulin. For people with
type 2 diabetes, their body makes
insulin, but their cells dont respond
to it. In both cases, levels of glucose
in the blood get too high and can
cause serious health problems.

Part 2 of 6

Why oral insulin?

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If you have any type of diabetes, keeping your blood
sugar levels within your target range is vital. Not doing
 so raises your risk of serious health problems such as
blindness, heart disease, kidney disease, and nerve
damage.

To keep your blood sugar levels in a safe range, you

have to follow your diabetes treatment plan. For many
people with diabetes, this involves insulin injections.
These injections can be inconvenient, they require
training to self-administer, and they may need to be
given several times per day. And, of course, they involve
needles, which many people dont like. For all of these
reasons, many people dont follow their diabetes
treatment plan, which can lead to severe complications.

So, the idea that you could get your dose of insulin by
simply swallowing a pill appeals to many people.
Doctors believe that the ease of using a pill could make
more people willing to start and maintain a successful
insulin therapy routine. That could lead to better
control of their diabetes.

Part 3 of 6

How oral insulin would

work
With injectable insulin, you use a needle to inject the insulin into the fatty
tissue beneath your skin. From there, the insulin travels to your bloodstream.
It goes into general circulation throughout your body and then travels to
your liver.

Oral insulin, on the other hand, would

move through your digestive system. It
would be absorbed into your
bloodstream through your intestines.
From your intestines, it would move
High and low blood sugar
Insulin is used to prevent
hyperglycemia, or high blood sugar
levels, in people with diabetes. But if
you have too much insulin in your
into your portal vein, a blood vessel
that connects to your liver. Then the
insulin would move directly into your
liver, where glucose (blood sugar) is
stored.
body, too much sugar would move
into your cells, leaving you with
hypoglycemia. Managing diabetes is
a balancing act of keeping your
insulin and blood sugar levels in a
healthy range.

The process with oral insulin would

more closely mimic the movement of natural insulin in your body than
injectable insulin does. Moving insulin more quickly into your liver could help
your body absorb and use glucose better. This could mean the insulin works
faster. It could also mean a reduced risk of excess insulin in your blood,
which could lead to a decreased risk of hypoglycemia (low blood sugar).

Part 4 of 6

Why we dont have oral insulin yet

We havent developed a type of oral insulin that can make it through the
digestive system unharmed. The acids in your stomach break down oral
insulin before it can get to your liver. That means its not effective by the time
it reaches your liver.

Further, your body has trouble absorbing insulin from your intestines. The
mucus layer in your intestines is thick, and studies have shown that only low
levels of insulin pass through this lining and into your bloodstream. As a
result, some researchers believe that high doses of insulin would be needed
to be effective in managing diabetes.

Many clinical trials have been done on oral insulin, but no form of the
treatment has made it through the trials successfully. The good news is, none
of these trials has shown major health risks from oral insulin as compared to
injectable insulin.

However, researchers are concerned

that oral insulin could raise the risk of Diabetes prevalence
certain types of cancer. This is because According to the Centers for Disease
large amounts of insulin would be Control and Prevention, over 29
needed to make it through the million Americans have diabetes.
digestive system. Insulin is a growth- More than eight million of these
promoting substance, and large people have not yet been diagnosed
amounts of it could promote the with the disease.

growth of cancer cells. The bottom

line, though, is that there's no established link between oral insulin and
cancer.

Part 5 of 6

Current and future options

While researchers continue to strive for a pill form of insulin, another form is
now available. Afrezza inhalation powder was approved by the Food and
Drug Administration in 2014. Using an inhaler, you breathe in this drug at the
start of a meal to help control spikes in blood sugar after your meal. The
drug is absorbed into your bloodstream through the walls of your lungs. This
method is not quite as desirable as a pill form, as it doesnt go into your liver
as quickly.

You can use Afrezza if you have type 1 or type 2 diabetes. However, with type
1, you must use injectable insulin as well.

Clinical studies are ongoing for other oral forms of insulin. For instance, a
buccal spray is being studied. This drug would be sprayed into your mouth
and absorbed into your bloodstream through the mucus membrane of your
cheek.

Part 6 of 6

Talk with your doctor

Although an insulin pill isnt yet available, its likely just a matter of time
before medical science achieves this goal. In the meantime, be sure to work
with your doctor to manage your diabetes with the treatments that are
available.

If you have questions about oral insulin, your insulin treatment plan, or
diabetes in general, talk to your doctor. They can work with you to create or
manage a treatment plan thats best for you. Questions you may have for
your doctor include:

Would Afrezza be a helpful option for me?

Can I use a long-acting insulin so that I can give myself fewer injections?
Are there oral treatment options that would work just as well as insulin
for me?
What other diabetes treatments do you think will be available in the near
future?

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