Oral insulin… What a dream!!!
What is insulin?
It is a hormone released from the pancreas. Insulin is responsible for glucose utilization by the body organs.
It facilitates the transfer of glucose into the body cells. Therefore, it is essential for treating type1 diabetes mellitus.
Some cases of type 2 diabetes mellitus are in need of insulin as well as oral diabetes medications in order to maximize glucose control.
Insulin is available only in the injectable form because stomach acid has a damaging effect on insulin.
So, it is not available in any form other than the injection form because:
The acid present in the stomach can degrade the oral insulin. Thus, the patient won’t get the desired effect.
In addition, there is poor absorption of oral insulin from the intestine because large molecules are unable to cross the intestinal mucosa.
Moreover, it is difficult for insulin to cross the intestinal wall through blood, so it wouldn’t reach the circulation.
Side effects of insulin injection
- Lowering blood glucose with manifestations such as dizziness, sweating, pallor, and weakness.
- Usually, the patient will gain weight initially.
- The appearance of swellings at the site of injection as well as rash and discoloration.
- Some patients experience depression while others show manifestations of anxiety.
- Damage to the fat just beneath the skin.
It was a dream of both patients and physicians in order to avoid the troubles of injecting insulin such as pain and skin troubles.
Recent studies on animals offer some hope towards these dreams. It showed that insulin can be taken in an oral form.
Oral insulin (oramed) is in the form of a capsule containing a digestible micro-needle with dried, freeze, and compressed insulin.
There is a sugar capsule that will dissolve in the stomach. This will release the insulin micro-needle that will inject its content of insulin in the lining layer of the stomach.
This injection will go painless because there are no pain receptors in the wall of the stomach.
Later on, the capsule will pass to the intestine without causing any harm.
There was another suggestion, to use enteric coated tablets of insulin. But, it is not enough to release insulin in the small intestine rather than in the stomach.
Scientists suggest adding a Permeation enhancer in addition to insulin in order to facilitate its absorption through the intestinal wall.
The expected benefits of oral insulin tablets
Indeed, diabetic patients would prefer oral insulin tablets more than the injectable form.
It should provide a relatively natural way of delivering insulin in the same pathway that happens inside the body.
The insulin is better absorbed from the wall of the intestine.
It reduces the burden on the patient’s diseased pancreas.
The dose is enough to the patient’s requirements so that there is no risk of having a low blood sugar level.
There is no need for repeated injection which allows better patient compliance. In addition, they save the patient from the side effects of injected insulin.
There is less risk to have weight gain secondary to the usual diabetes treatment.
Insulin will pass to the blood directly. Thus, a small part of this insulin will be damaged and a secondary better control will be achieved.