‘Smart’ insulin prevents diabetic highs — and deadly lows

In animals, the molecule automatically reduced blood-sugar levels without causing them to dip too much.

Originally published By Diana Kwon, Nature, on 16 October 2024


Crystals of insulin. A new kind of insulin can modify its activity in response to glucose levels in the blood.Credit: Antonio Romero/Science Photo Library

Scientists have designed a new form of insulin that can automatically switch itself on and off depending on glucose levels in the blood. In animals, this ‘smart’ insulin1reduced high blood-sugar concentrations effectively while preventing levels from dropping too low.

For people with diabetes, controlling blood-sugar levels is a crucial — but demanding — task. Insulin keeps blood glucose in check, helping to prevent the many long-term complications associated with high blood sugar, such as cardiovascular disease, chronic kidney disease, stroke and blindness. A large proportion of the estimated 422 million people with diabetes worldwide require insulin injections.

But excess insulin can cause blood-sugar levels to dip too low, a condition called hypoglycaemia, putting people at risk of serious complications, such as loss of consciousness, seizures and even death. Even mild or moderate hypoglycaemia can cause anxiety, weakness and confusion. People with diabetes — particularly those with type 1 diabetes, who always need to inject insulin — can have drops in blood-glucose concentrations several times a week, says Michael Weiss, a biochemist and physician at Indiana University in Indianapolis. “It really impairs quality of life.”

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