India is the Diabetic capitol of the world!

* According to reliable estimates nearly 10% of diabetics have Insulin dependent or type I Diabetes. Moreover, 7% of type II Diabetics may eventually require Insulin. This means that as many as 7 million people in India require Insulin to manage their Diabetes.
* On an average an Insulin dependent patient has to take as many as 60,000 injections throughout his life to keep his diabetes in check.
* A large number of Insulin dependent patients tend to discontinue treatment owing to unpleasant side effects of injectable Insulin, notably Hypoglycemia.
* Diagnosis and management of diabetes is critical because diabetes and cardiovascular risks often affect the same patient populations.

Quite clearly Diabetes is acquiring epidemic proportions in the country.

It merits mention that any effective strategy aimed at countering Diabetes has to be necessarily an all - encompassing one. It is therefore eminently desirable to consider all aspects of the diabetes problem. An aspect that has so far received less attention than it deserves is what may be called 'compliance to treatment'. Statistics have it that a large number of Insulin dependent people discontinue treatment on account of the side effects that injectable Insulin brings on.

Diabetes is a condition in which the body either does not produce sufficient amounts of the hormone Insulin or does not respond to the Insulin produced. This leads to high blood sugar levels leading eventually to life threatening complications.

The rationale behind the treatment is quite simple. If your body is not producing Insulin, it needs to be provided from the outside. As of now the only recommended way of doing that is to inject it subcutaneously (under the skin) from where it is absorbed quickly. If, on the other hand, your body is resistant to the Insulin that it produces, you need to lower that resistance. This is achieved through drugs known as Oral Hypoglycemic (sugar - lowering) Agents.

Insulin injected subcutaneously (under the skin) and finding its way quickly into the blood has a potential of causing what is known as Hypoglycemia (dangerously low levels of blood sugar, which may prove fatal), characterized in the initial stages by manifestations like sweating, palpitations, anxiety and pallor and in the later stages by slurred speech, paralysis, coma and even death. This effect is not seen with drugs, which reach the blood much more slowly. That explains why many people on injectable Insulin tend to discontinue treatment. It goes without saying that a discontinuation of treatment has serious repercussions in terms of final outcomes in a condition like diabetes.

Cutting edge clinical research is endeavoring to bypass this problem. Researchers throughout the world are continuously striving to come up with newer methods of Insulin delivery - methods that would help avoid episodes of hypoglycemia.

Oral Insulin is an exciting development in this connection. Developed by an American biopharmaceutical company, is already being used patients, delivers Insulin through the Buccal Mucosa (the inside lining of the mouth).

It is emerging as an exciting prospect for researchers and clinicians alike for it is possible to control the number of puffs thus the quantity of insulin delivered to the body In addition to the possibility of averting episodes of Hypoglycemia, oral Insulin also offers ease of administration and convenience as also freedom from the all too frequent and annoying needle pricks.

The device design makes it possible for patients to carry Oral-Insulin device in their coat pockets or hand bags and doesn't require refrigeration. The ease of using the device doesn't require privacy that is needed to administer an insulin injection.

Says Dr. Vijaya Sarathi, Diabetologist, Kem Hospital, Mumbai, "Oral insulin is an alternative mode of insulin delivery, because of less bio-availability the dose required is high. Efficacy and potency is same this is best suited for those requiring less dose of insulin. Oral Insulin has the potential of ensuring better patient compliance since it doesn't have to be injected. Better compliance lead to improved glycemic control and thus minimize the serious diabetic complications such as diabetic foot etc. Moreover, the chances of hypoglycemia with oral Insulin are significantly lower compared with Injectable Insulin" The key design advantage is Insulin is not delivered to the lungs as in other non-injectable insulin systems.

As of now Injectable Insulin is the mainstay of treatment for people with type 1 or Insulin Dependent Diabetes Mellitus. In exploring alternatives we are, of course, seeking better compliance and freedom from side effects. What we are also seeking is an evolving treatment modality that helps us vanquish the disease completely in near future.

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