Isabelle Steineck - Dual hormone treatment in T1D: beyond the artificial pancreas

Dual-hormone treatment with insulin and low-dose glucagon is a sparsely explored area except in artificial pancreas (automated) systems. However, dual-hormone treatment has the potential to improve the quality of life and glycemic control in a majority of patients with type 1 diabetes, including both patients treated with multiple daily insulin injections and with insulin pumps. Stable, liquid glucagon formulations with similar action profile as the current unstable glucagon products are under development by more companies including our collaborator Zealand Pharma.

Guidelines for type 1 diabetes recommend intensive insulin treatment in the management of type 1 diabetes. Intensive insulin treatment, however, increases the frequency of mild hypoglycemia. The need to frequently treat hypoglycemia with oral carbohydrates may contribute to weight gain. Recent data estimate that more than 50% of the type 1 diabetes population is either overweight or obese. Further, fear of weight gain together with fear of hypoglycemia may drive patients to keep less stringent glucose control. We suggest that instead of frequently treating mild hypoglycemia with carbohydrates intake, low-dose glucagon pen injections could be an attractive non-caloric alternative treatment option for mild hypoglycemia in patient with type 1 diabetes.

This PhD project aims to include four human studies to be performed in Denmark and training in Boston, by our well-known collaborators within this research field. The studies will explore the limitations in using glucagon to treat mild hypoglycemia in patients with type 1 diabetes. The results obtained will be of value also in the development of the dual-hormone artificial pancreas. Until soluble glucagon will be available from our collaborator, our studies will be performed with existing glucagon formulations.