Savvy Updates, 2/14/22: Spare a Rose Save a Life (IDF), Eversense 180-day Implanted CGM Approved by FDA, Faster/Better Delivery Insulin, Valentines for a T1D

An AMAZING way to celebrate Valentine’s Day … and support a child with T1D!

For a most impactful gift, you can make a beautiful and immeasurably powerful statement by support the Spare a Rose campaign.

Spare a Rose is about making a small donation to the International Diabetes Federation’s Life for a Child program, which provides life-saving insulin and diabetes resources for children in developing countries. The idea is to send 11 roses and spare one rose – valued at $5 USD – as a donation to Life for a Child.

Nothing says “I love you” like saving a life, and this Valentine’s Day, you can make a difference that far outlasts the holiday.

Senseonics lands long-awaited FDA approval for 6-month implanted CGM system was reported by Andrea Park for FierceBioTech.com, 11 February 2022.

More than a year after submitting its application to the FDA—and many months later than Senseonics expected to receive the agency’s sign-off—the diabetes technology developer has finally scored approval for its implanted continuous glucose monitor designed for long-term use.

The Eversense E3 sensor can be used for up to six months, longer than any other CGM system currently on the market, and requires calibration only once per day with fingerstick blood draws, rather than the twice-a-day requirements of past models. When compared to readings from traditional blood sugar meters, the sensor’s results deviated just over 9% of the time on average. It was also able to alert users to instances of hypoglycemia with 93% accuracy.

The Eversense E3 CGM System offers patients:

- Fully implantable third-generation sensor, with proprietary SBA technology to enhance sensor longevity, demonstrating a mean absolute relative difference (MARD) of 8.5% in the PROMISE Study.
- Industry-leading 6 month sensor wear duration, making Eversense the longest-lasting CGM system available, with essentially two sensor insertion and removal procedures per year.
- Removable smart transmitter, held in place with a mild silicone-based adhesive, provides discreet on-body vibratory alerts and data transmission to a mobile app where glucose values, trends, and alerts are displayed.

“Further extending the duration of the longest-lasting CGM system to six months represents a massive leap forward for patients and towards our mission of transforming lives in the global diabetes community,” said CEO Tim Goodnow, Ph.D. “The [FDA] review was delayed by one year due to COVID-19 priorities and now together with our partner Ascensia, we can execute our launch plan to deliver the Eversense E3 CGM system to U.S. patients beginning in the second quarter.”

QUESTION TO MY READERS: Are you tempted to try the 6-month Eversense CGM? What are the biggest drawbacks to you? Do you have any questions about this system?

Insulin’s second century was published by Celia Henry Arnaud for Cen.acs.org/pharmaceuticals, 30 January 2022.

Before the discovery of insulin, type 1 diabetes was a death sentence. That prognosis started to change on Jan. 11, 1922, when 14-year-old Leonard Thompson became the first person with diabetes to receive an injection of a pancreatic extract from dogs. We now know that extract contained insulin. That first extract wasn’t very pure, so although Leonard’s blood sugar decreased, the overall effect was disappointing. About 2 weeks later, Leonard received an injection of a purer extract, and the results were more promising. That same month, six other people with diabetes also received injections that reduced their blood sugar levels. Those trials at the University of Toronto marked the beginning of a lifesaving treatment for type 1 diabetes.

In the 100 years since Leonard received his first dose, insulin has become well known. Scientists purified, identified, and characterized the peptide; elucidated its role in glucose metabolism; developed biotechnology processes for producing large quantities of it; and engineered analogs that can work faster or for longer periods.

Yet even with all these advances, academic and industry researchers continue to look for ways to improve insulin and thus improve outcomes for people with diabetes. “There is as much to be done chemically with insulin today as there’s ever been in its history,” says Richard D. DiMarchi, a chemistry professor at Indiana University Bloomington who was previously a vice president at Eli Lilly and Company and Novo Nordisk, two of the three major producers of insulin. “While this is a miraculous substance, it is an imperfect and, one might say, lousy drug by conventional standards.”

INSULIN BASICS

Insulin is a peptide hormone that regulates the metabolism of carbohydrates, fats, and proteins. β Cells in the pancreas secrete insulin in response to glucose in the blood. Insulin, which has an A chain and a B chain held together by disulfide bonds, exists in an equilibrium of monomers, dimers, trimers, hexamers, and dodecamers, says Michael A. Weiss, an insulin expert at the Indiana University School of Medicine. Whereas the main storage form of insulin in β cells and in most drug formulations is a hexamer coordinated with zinc, the active form in the blood is the monomer.

What makes insulin a “lousy drug” is its narrow therapeutic index. The therapeutic index is the difference between an effective dose and a toxic dose—and in the case of insulin, either too much or too little can be dangerous. If a person takes too little insulin, they don’t metabolize glucose effectively. That can lead to long-term complications, such as cardiovascular disease, nerve damage, and kidney damage. But if they take too much insulin, they run the risk of hypoglycemia, an emergency condition that can lead to coma and death if not reversed in time.

FASTER

One challenge to speeding up insulin response times is that insulin has to dissociate from hexamers to monomers, its active form. Although monomeric insulin would be absorbed quickly, it is too unstable for direct use as a drug. “You simply cannot make a drug product of it and ship it around the world,” Eric Appel, a materials scientist at Stanford University says. Appel has identified a polymeric additive that prevents aggregation by blocking protein adsorption to interfaces, such as the air, glass, rubber, and plastic in vials, pen injectors, or pump systems. He has started a company called Surf Bio to commercialize the new additive. The company has started nonclinical toxicology studies. Appel expects it will take 5 years to get through Phase 3 trials and fully commercialize the new ultrafast monomeric insulin drug candidate and the additive that enables it.

Indiana University’s Weiss is also working on ways to stabilize insulin against amyloid formation. To do that, his team is exploring ways to make heat-stable insulins in which the A and B chains are covalently connected by short peptide linkers. Weiss founded the company Thermalin more than a decade ago to develop novel insulin molecules, such as the heat-stable ones and others that are optimized to enable the miniaturization of devices for the automated delivery of insulin.

SELF-ACTIVATING

One of the best ways to avoid hypoglycemic events would be to develop insulins that can respond to glucose. Researchers are taking multiple approaches to create such designer insulins.

One approach is to encapsulate insulin in glucose-responsive materials. These insulin storage depots have the advantage of lasting for a long time, says Danny Hung-Chieh Chou of Stanford University, who is working on various forms of glucose-responsive insulin.

Zhen Gu, a materials scientist at Zhejiang University, and his coworkers are developing a glucose-responsive microneedle patch that can deliver insulin across the skin. Insulin and phenylboronic acid are embedded in the polymeric microneedles. When glucose forms a complex with phenylboronic acid, the microneedles swell and release the insulin. Gu and his colleagues have used such patches to control blood glucose levels in diabetic minipigs (Nat. Biomed. Eng. 2020, DOI: 10.1038/s41551-019-0508-y).

The second general approach to creating glucose-responsive insulins is to add a glucose-sensing moiety directly to insulin. This has proved to be challenging, but researchers are optimistic that it will eventually work.

Read more: Insulin’s second century

Valentine’s Day Gift Guide for People With Diabetes was written by Kerri Sparling for ASweetLife.org, 8 February 2018. Yup, this was posted 4 years ago but the advice hasn’t changed. I’ve included links in case something strikes your fancy.

A thoughtful gift goes a long way this time of year, and the point is to show someone that they’re loved, not necessarily that they’re “diabetic.” These are just suggestions with a diabetes twist, letting your loved one know that you love them entirely, from head to toe, including that busted pancreas in between.

Does your Valentine have a sweet tooth? We have some delicious options in A Sweet Life database that are decadent without the blood sugar destruction powers. Bake up some brownie batter truffles, or our turtle brownie bites, or don’t bake these no-bake chocolate brownie energy bars as a gift.

Jewelry is always a good go-to gift for any Valentine, but you can add a special spin by adding the gift of protection for your PWD. A medical alert bracelet or necklace is a beautiful gift for your loved one and also helps them stay safe in case of an emergency. The folks at StickyJ Medical and Lauren’s Hope have designs for men, women, and children that say, “I love you” while simultaneously saying, “And I want to help protect you.”

And if your loved one already has medical alert jewelry, you can go one step further with a diabetes-themed piece of jewelry. Like this glucose molecule necklace – a great way to keep glucose on you at all times! (But please make sure you include a jar of glucose tabs, so they’ll have a glucose source they can actually eat.) You can also purchase an anatomically correct, sterling silver pancreas pendant if that’s your thing or a pancreas lapel pin.

The Internet’s t-shirt game is strong when it comes to diabetes-themed shirts, and on Valentine’s Day, these fashion statements could be the perfect gift. There’s a shirt for pancreas-eating zombies, or maybe a T-Rex ate your pancreas, or perhaps your pancreas chose the dark side? Whatever your preference, there’s a shirt for that.

Mugs are always popular gifts for your eco-conscious, caffeine-swigging Valentine. There are mugs for full time blood sugar ninjas, carb-counters, and those who keep calm and diabetes on. Double down with some of your loved one’s favorite teas or coffees and you have a gift fit for your favorite friend.

Since people with diabetes are always reading their glucose meter or their insulin pump screen, it might be nice to take a break from all those numbers and focus on some words. Empowering, inspiring words make for a great gift, and we have a long list of books perfect for the person with diabetes in your life. Check out our low-carb book list, or this list from SixUntilMe, and you’ll have a library of inspirational choices at your fingertips.

And into CHOCOLATE? Check out Diabetes and Valentines posted on Diabetes.co.uk, 15 January 2019.

Enjoy your Valentine’s Day and remember that as someone with diabetes, you’re naturally a little sweeter than most!.

As a diabetic, the last thing you may want is chocolate but not all chocolate is created equal, with some being better than others. If your partner is diabetic, look for chocolates with a higher content of cocoa solids and relatively low amounts of sugar and fat. A smaller quantity of better quality chocolate is a better pick than larger quantities of lower quality. Diabetic chocolate can be hit and miss.

Possibly better than chocolate is a good flavourful meal. A good selection of fresh herbs and spices is a great way to enhance a meal as well as providing extra nutritional value, making them a better choice than salt and sugars.

Read more: Diabetes and Valentines