Hi, my name is Doug and I’m worth a small fortune to the pharmaceutical industry.
I’ve been a type 1 diabetic for 31 years — since I was three years old — and some of my earliest diabetes-related memories were of doctors telling me that a cure was roughly five to ten years away. All the time, just five to ten years away. Every year. My gut feeling now is that I’ll probably be living with this disease for the rest of my life. More on that later.
My absolute oldest memory, as a person, happens to be a diabetes-related memory as well. I remember pressing my nose up against the glass at the cookie counter at Target, pointing to a giant cookie slathered in icing so that it resembled Cookie Monster, and eating it without consequence. That would have had to have happened before I was diagnosed as diabetic, because such an activity nowadays would require several steps to pull off smoothly.
How Type 1 Diabetes Works
The short version about how type 1 diabetes works is as follows: when I eat, my blood sugar levels go up. Eating sugary stuff makes them go up further and faster than non-sugar stuff. Injecting insulin drives my blood sugar levels back down. If I inject too much insulin, I need to eat to drive my blood sugar levels back up.
Your blood sugar level probably hovers at around 100 all day. Mine could be anywhere between 50 and 400. Some people go much lower and much higher. Anything outside of about 100 to 200 for me, and I start feeling like I’m drunk but not in a fun way (low blood sugars) or dehydrated and sickly (high blood sugars).
Much of my life is spent trying to make sure to eat the perfect amount of food while injecting the perfect amount of insulin, so that my blood sugar levels stay as perfect as possible. Your body does this automatically, because your pancreas isn’t a deadbeat like mine. It senses when you eat and when your blood sugars start to elevate, and then secretes insulin – the perfect amount – into your body to stabilize your blood sugars.
How the Google System Should Work
So, onto this Google Smart Contact Lens thing. The idea behind it – and I’m going to take what Google says in its blog post and extrapolate the idea a bit – is that there’d be a pre-defined range of blood sugar levels deemed as “OK” by a tiny sensor built into the lens, and if my blood sugars were higher or lower than that range, I’d be notified somehow.
One way would be to wirelessly transmit the data to a handheld device – oh, maybe a Google-infused Android phone – but Google also mentions embedding tiny LED lights into the contact that could flash when certain things happen. This is actually a more ideal scenario than the wireless transmission idea, but you could probably just build both features into the contact lens and be done with it.
Of more value than simply knowing my blood sugars are higher or lower than they should be, however, is knowing whether they’re trending upward or downward and how quickly it’s happening. If I eat a delicious, icing-covered Cookie Monster cookie, I’d ideally see a red light blinking like crazy, telling me that my blood sugars are skyrocketing. If I ate an apple, I’d ideally see a slowly pulsing, pink-ish blink that told me that my blood sugars were elevating ever so slowly.
Conversely, if I gave some pre-dinner insulin, knowing that I was going to eat in 20 minutes or so, I might see a faint blue pulse as the insulin started to take effect. If I got stuck waiting for a table in a restaurant and it’d been an hour since I’d given myself insulin, I’d see a flashing purple light shaped like a skull and crossbones or whatever.
There are a few systems like this already, although you don’t wear them on your eyeball. I use this Dexcom system, which consists of wearing this little patch thing somewhere on my person – the patch has a tiny, needle that sits under my skin at all times – and relays data to a device about the size of an iPod Nano, but thicker. So what Google’s doing isn’t a huge breakthrough for diabetics – it’s simply a way to wear it on your eye, and hopefully it’s less cumbersome and cheaper than existing solutions.
Getting to Market
Google’s blog post says the following:
We’re in discussions with the FDA, but there’s still a lot more work to do to turn this technology into a system that people can use. We’re not going to do this alone: we plan to look for partners who are experts in bringing products like this to market.
As a diabetic for 30+ years, I can translate that for you: This thing won’t be here for at least 10 years. Google may be able to use some of its girth to move things along a bit more quickly, but I personally don’t plan on being able to get my hands on this until I’m in my mid-forties.
The most interesting bit of that quote is that Google is looking for “partners,” plural. This system will ostensibly work like Android, with several different companies leveraging the technology in their own products.
Therein Lies the Rub
There’s a lot of money to be made from diabetics. If you’re looking to start your own pharmaceutical company, we have a great disease: It’s just dangerous enough that we could die, but it’s totally manageable on a day-to-day basis – every day for the rest of your life, and I plan on living just as long as any non-diabetic would.
One time when I was out of town for the weekend, the insulin injection device I had with me broke. The seal between the vial holding the insulin and the plunger used to inject the insulin must have come apart somehow, because when I woke up one morning, all the insulin had leaked out. So I took the device – called an insulin pen (because it looks like a pen) – to CVS to get a replacement.
Well, you can’t just get a replacement. These things don’t have warranties. I wasn’t due for a refill, so my insurance wouldn’t cover it and, long story short, I had to buy five insulin pens out of pocket for almost $900. I buy five pens a month of this type of insulin and another five pens a month of another type of insulin, plus blood sugar testing supplies and other odds and ends related to the disease.
That’s the kind of money that gets spent on insulin. Granted, insurance covers a lot of it, but the pharmaceutical company still gets a big chunk of it. Even with insurance, I still spend around $200 to $300 a month on supplies. And in the above instance, I can’t just not buy insulin unless I want to go an entire weekend without eating anything with even trace amounts of carbohydrates or sugar in it.
So for all the diabetic advancements, the dependence on insulin remains the one constant. These blood sugar testing innovations are great, but if you fix the insulin problem – the lazy pancreas — you fix everything else. Everything.
The Bigger Issue
The “Let’s find a cure!” storyline – fixing the pancreas — I’d been hearing for my entire childhood and into the beginning of my adult life gradually shifted to one of insulin pumps, high-tech blood sugar monitoring devices, and artificial pancreases (which are basically insulin pumps merged with high-tech blood sugar monitoring devices). “Let’s find a cure” turned into “Let’s make diabetes so easy to live with, you don’t even think about it.”
Instead of just getting my pancreas to start working again – and there’s plenty of research going on right now suggesting such a feat is possible (I’m a participant of one such study; I’d rather not name it so it can keep flying under the radar a bit) – the idea now is to put the management of the disease on autopilot, which still entails buying expensive insulin. Ideas that are true breakthroughs toward finding a cure somehow seem to mysteriously never go anywhere, get ridiculed as pseudoscience or get bought up and are never heard from again. I’m sure there are plenty we never hear about at all, either.
The bottom line is that if my pancreas starts working again, the pharmaceutical industry loses out on hundreds of thousands of dollars I’d spend on diabetes over my lifetime. They need me to keep buying insulin. And just think of how many people would be out of work if diabetes was cured. It’s an enormous industry that won’t go quietly.
How to Find a Cure
This is the eternal question if you’re a diabetic, and the answer – in my humble opinion – is that someone needs to come along with enough eff-you money that no pharmaceutical company can stop them.
Google is actually a perfect candidate for this right now. Bill Gates’ philanthropic foundation might be another possibility. But it’s not going to be some small, brave, insightful team toiling away in a lab somewhere. Those guys seem to get eaten up faster than a working pancreas beating back a Cookie Monster cookie.
Don’t get me wrong: I’m still holding out hope for a cure. And this Google thing is a nice step toward making living with the disease more comfortable. But the reality is that there are a lot of people with a whole lot of incentive to keep things status quo. If someone in the tech industry truly wants to disrupt something, then curing diabetes – instead of continuing to build gadgets for diabetics — would be one hell of a disruption.