Insulin and Holy Grails

I seem to have something like the anti-Midas touch going on today at work. Instead of turning everything I touch into pure gold, it turns into a freaking neutron bomb, blowing away my MATLAB session when I run the test suite. I’m taking some existing image processing code and using it in a multithreaded harness I wrote a while back. The goal is to easily exploit data parallelism for the newish generation of multicore CPUs. You can see some of the resulting performance wins — though I didn’t do all of the work, and it doesn’t all use this framework.

Anyway, I’ve managed to kill MATLAB more times today than I’d care to admit because of some threading issues in my sandbox. My sanity needs a break while I get myself into a frame of mind to look for threading issues. (That pretty much comes down to asking yourself, “What’s not happening here? What other threads might be giving this data ‘the bad touch?’”) While I let my brain settle down, why not put the final touches on this post about insulin?

Insulin is our frenemy, but what do we really know about it? Here are some recent articles about insulin.

  • Mind the GAPP: Insulin Therapy Woes. An industry group discovered “interesting” things about insulin — such as, 1/3 of people with diabetes (PWDs) skip insulin doses or don’t follow their doctor’s Rx exactly — and along the way manages to get some of us patients a bit indignant.
  • Insulin and Bone Fractures [PDF]. A paper presented at EASD last week exposes the correlation between insulin and bone fractures. It seems that insulin can cause us to be clumsy and fall when we are driving the magic bus have hypoglycemia. Other than being more inclined to feel the effects of gravity, our bones are otherwise unchanged.
  • Novo says cancer risk with insulin drops over time. Evidently there’s some link between insulin and cancer, but the incidence decreases the longer one is on insulin. “Furthermore, the marked drop in risk with long-term insulin use indicate that other factors than insulin may play an important role.” Huh. . . .
  • Sanofi-Aventis Seeks the Holy Grail of Insulin. Um. Okay. This article, which is written for people trying to decide which bio-pharma stocks to buy, has a pretty good recap of the three new fast-acting insulin analogues that may be coming to market within the next few years: Mannkind’s Afrezza inhaled insulin, Biodel’s Linjeta injected insulin, and Halozyme’s rHuPH20 insulin additive/friend/thing. There’s a fair amount of doubt in the minds of PWDs about inhaled insulin — especially since recent research “demonstrates that inhaled insulin rapidly forms amyloid in the lungs causing a significant reduction in pulmonary air flow.” Yikes. And while I know almost nothing about it, Provasic rHuPH20, according to the Seeking α article, uses “an enzyme called hyalronidase that locally degrades body components under the skin to enable quicker absorption of a drug (like insulin) into the blood.” I think I’ll pass. Linjeta sounds cool: faster than Novolog, Humalog, or Apidra; undergoing safety and efficacy tests for injection and insulin pump usage; not likely to “disrupt tissue structure;” etc. But about that “holy grail” comment. . . . I have to disagree with the idea that an insulin to mix with Lantus so that PWDs can have one meal-time-slash-any-time insulin is really equivalent to the Cup of Christ. Maybe for the drug companies, since some type 2 PWDs will have something new and expensive to replace their 70/30 insulin once it goes off patent, but c’mon. Let’s keep some perspective. Srsly!
  • New insulin could cut need for daily injections. Er, “some” daily injections. That is, insulin degludec — if effective and safe — might be able to replace your daily Lantus injection with a thrice-weekly injection. “Researchers found that the variability of treatment effects was lower among patients given insulin degludec than standard treatment.” And “an accompanying study showed that insulin degludec injected three times a week was as effective at lowering HbA1c levels as existing type-2 diabetes therapy.”
  • Biopharmaceutical Companies Developing a Record 235 Medicines to Treat Diabetes and Related Conditions [PDF]. In case one of the four insulins above doesn’t get your juices flowing, here are 231 other diabetes medications for you.
  • The implant that can free you from insulin jabs. First off, I didn’t know there was a link between insulin injections and migraines. The article is kind of a hot mess, but it also picks up the Grail theme, saying that the “holy grail” of diabetes is an “artificial pancreas,” but not the one you’re probably thinking of. No, this one, which is undergoing preclinical trials, “is an implant placed above the hip containing a supply of insulin kept in place by a barrier of gel that reacts to glucose.” More glucose, more insulin. Easy, peasy. Right?
  • Lilly R&D Chief Pursues Late-Stage Drug License Deals. Yup, like Sanofi-Aventis, Lilly needs more of our diabetes-related total healthcare dollars, too.

None of this solves the basic question at hand of my inadvertently destroying MATLAB, but I think I’m ready to get back to it. Except, there’s a cookie here staring at me. If I eat it that means an insulin bolus, but that will make exercise more difficult. Choices. Choices. If only there were an awesome, Grail-looking chalice here to drink and/or dunk my cookie into.

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2 Responses to Insulin and Holy Grails

  1. Caroline says:

    Well, the first chunk of your post is in a completely foreign language, so I’m just going to shake my head and pretend to commiserate. :P

    But *235* diabetes medications?! Good lord! Let’s hope that 234 of them don’t go the way of Avandia. I’m also really really hoping for the superfast insulin to come out soon…..mostly because I’m really bad at bolusing 15 minutes before eating. :P

    Meanwhile…..I now have an urge to watch Monty Python!

  2. Jeff Mather says:

    Thanks for your heart-felt sympathy on my debugging problems, Caroline. It means a lot. :^)

    As a suspicious person who has been around the diabetes block a couple times, I’m not placing any bets; although if I had some cash that I could afford to lose, I’d probably put a $2 bet on the makers of Linjeta. I hope that this normal-sounding insulin gets approved — although there’s some evidence from India that it might not work as well as regular insulin for type-1 folks with A1c values of 9 and above. The true-believers in the stock hope the FDA approves it anyway. I can wait another year or two for the company (which is bound to make a ton of money if it’s approved) to fund a study showing which patients on the A1c spectrum it will really help. That way we can avoid more “If your doctor prescribed Avandia, you should call our law offices immediately!” commercials.

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