 Good evening, everyone. Welcome to another edition of Curiosity on Stage. This presentation is part of a series meant to discuss new and emerging technologies making a difference in Canada and also around the world. My name is Michelle Makarski. I am the science advisor at the Canada Science and Technology Museum and I am going to be your host this evening. For those of you attending with visual impairment, I am a woman with shoulder length brown hair and brown eyes and I am joining you this evening from my home office in the city of Ottawa which is built on unceded Algonquin Anishinaabe territory. Before we start I also want to thank those who are supporting us tonight. I'd like to thank first and foremost the Ingenium Foundation who is generously co-hosting this Curiosity on Stage series focused on the 100th anniversary of the discovery of insulin. We are truly grateful for the Foundation's support in amplifying Ingenium's mission and particularly inspired by their mission towards science for all. In addition to the Ingenium Foundation, I would also like to thank the National Research Council of Canada for their support in making this series more accessible through translations, captioning, and transcriptions. Curiosity on Stage is all about inspiring thought by bringing together experts to share relevant essential and engaging topics that matter. This particular series is significant as it commemorates the 100th anniversary of the discovery of insulin, a story which has its roots in Canada and has been profoundly transformative to lives all over the world. Tonight in conjunction with the Ingenium Foundation, I am delighted to introduce the second of three webinars in the thematic series Beyond Injections, 100 Years of Insulin, and the Future of Diabetes. As one of the most common medical conditions affecting Canadians, an estimated 2 million or one in 16 people have been diagnosed with diabetes. A century ago, this diagnosis would have been a death sentence. However, with the discovery of insulin, millions of lives have been saved and improved. Even though insulin saves millions of lives, it is not without risk. Insulin is fairly unique among drugs in that it is self-administered and self-dosed. In other words, it isn't a doctor that calculates your dosage and giving you your shot of insulin. It's either a patient or their caregiver. A person with diabetes takes insulin to keep their blood sugars in a normal range. This means deciding how much insulin they need to dose themselves with based on a variety of factors, including what time of day it is, which foods they've eaten, how much exercise they've had if they're under stress, and also any other unexpected blood sugar variations that need to be brought into range with additional insulin. If they mistime their insulin or accidentally take too much or if a whole range of other stuff happens, their blood sugar can actually drop dangerously low to the point of being deadly. Our guest speakers today invented a product that saves the lives of those that find themselves in this life-threatening situation. Therefore, today I am delighted to welcome two innovators who will be discussing their personal commitment to supporting other startup companies who are driving technologies that can help prevent severe low blood sugar before it ever occurs. Robert Oringer and Claude Fichet are the co-founders of LoCemia, the Montreal-based company that developed an innovative needle-free glucagon nasal power, which is used for treating severe low blood sugar. What makes this product so innovative is how easy it is to use, carry, and teach others, all things that are really important during an emergency situation. LoCemia's glucagon nasal powder assets were sold to Eli Lilly in 2015, and the resulting product is sold around the world today as Baccini, glucagon nasal powder. Now, if you are at our last presentation by Ron Schlein, you may remember that Eli Lilly was also the first company to commercially produce insulin in 1923. Robert Oringer is the chairman of LoCemia Solutions and also currently serves as chairman for AMG Medical, a Montreal-based healthcare company that is getting ready to celebrate its 50th anniversary. He has over 35 years as an entrepreneur, investor, and board leader in healthcare, primarily in diabetes, medical devices, and services. Robert's focus on innovation in the diabetes space stems from his experience of raising his two sons, who both live with type 1 diabetes. Dr. Claude Pichet is the CEO of LoCemia Solutions. He is also an active investor, board member, and advisor in numerous private biopharma and medical device companies, with an emphasis on companies that seek to prevent episodes of low severe blood sugar for people with diabetes who take insulin. Prior to leading the creation and development of Baccini, Claude worked at private, public, and startup biopharmaceutical companies, where he had his hands in research, regulatory affairs, marketing, operations, and business development. I hope you're as excited as I am to hear from these two innovators. Please join me in welcoming Robert and Claude to Curiosity on stage. Merci Michel. Thank you very much, Michel. I'll start this off with a few words in French. Je sais à me merci Michel et toute son équipe des efforts qu'on met en place pour cette soirée ce soir. Je m'aime aussi remercier tous ceux et celles qui assistent à notre session ce soir. On apprécie beaucoup le temps que vous nous donnez pour venir d'écouter à notre message ce soir. So on behalf of Robert and I, I'd like to thank Michel and the entire team for organizing this evening's session. And I especially want to thank all of you who've tuned in on an evening I guess late afternoon for some of you in the West to come and listen to this story. So as background to our discussion about entrepreneurs and technologies we've been working with these past few years, we'd like to give you some insights into the journey that led us to this point. So to do so, I'll be, Robert and I will both be kind of putting you into a time machine where we're going to be bouncing back and forth as much as 20 years or more to take you through the story that led to the formation of our company La Semia and eventually to the development of our product Baximi. Personally, my background, I'm a veterinarian. I went to vet school in Western Canada. I practiced in Calgary for about six years at which time I wanted a change and I was interested in the pharmaceutical industry. So I was fortunate enough to be hired by Merck Frost Burke, the big multinational pharmaceutical company in their veterinary pharmaceutical division. I spent almost 10 years with Merck in Calgary for a couple of years, head office in Montreal for a few years, and then global head office in New Jersey for four years, various roles, marketing, clinical research, regulatory affairs, product development. And I left the company after about 10 years to join a startup in Colorado. So I went from Western Canada to Montreal to New Jersey back to the West this time in Colorado to a company that was working on long-acting injectable drug delivery. So we were working to take drugs that had to be injected two or three times a day to make it, for example, a once a day injection. And one of our projects was an ultra long-acting basal insulin for people with diabetes. We were targeting a once a week basal insulin. And that's when I stumbled into diabetes. I became enamored with the entire space, the medicine, the science, the business of diabetes. I found absolutely fascinating. And so for the last 20 years, over me, it's an introduction through my profession that I got into diabetes. So that's been my space for the last 20 or so years. Now, before I move on to the story, I think I need to give a little bit of background about hypoglycemia and glucagon in particular. So for those of us who don't have diabetes, like me, we have this incredible organ called a pancreas. And many of you already know this, but the pancreas produces many hormones, but two really key hormones in glucose control are insulin and glucagon. They're kind of like the yin and yang of glucose control. So when we, people who don't have diabetes, eat a meal, the pancreas will detect that our blood glucose levels are going up. The pancreas will produce insulin. That insulin goes from the pancreas directly to the liver and then to the other organs in the body. On the other hand, if we don't eat, or let's say we exercise strenuously, and our glucose levels start to drop, that same organ, the pancreas, will produce glucagon. And that glucagon will go directly to the liver, and it'll stimulate the liver to release glucose that it's been stored into circulation, and that way bring back our glucose levels. So between insulin and glucagon, we have this kind of gas pedal break that keeps our glucose levels in a pretty tight range for those of us who are fortunate enough to have a highly functional pancreas. Now for people who have to take insulin, if they're type one because they're not producing insulin, or type two because they're no longer responding to their insulin, controlling the blood glucose levels is really a challenge. There are so many factors that affect your glucose levels, it's almost impossible to do this by ourselves. So people with with diabetes on insulin frequently experience hypoglycemia and hyperglycemia, so it's often going too high, often going too low. Now with hypoglycemia, we have three categories, we call level one, level two, level three, or you can just call it mild, moderate, severe. Mild and moderate hypoglycemia, people feel it coming on, they can self-correct by ingesting, for example, a glucose tablet or some orange juice or a cola or a candy bar to bring their blood sugars back up. That probably happens easily once a week, maybe twice a week. I don't want to sound like it's not a problem, it actually is, it's a big disrupter in the lives of people on insulin. Even mild or moderate hypoglycemia can kind of mess up a day, but at least they can be self-treated. Then we have what we call severe hypoglycemia. Now severe hypoglycemia by definition simply says it's a hypoglycemia that requires the assistance of a third party to treat it. So the person may be unconscious, may be in convulsions, or may be severely disoriented and not really in a position to eat. So you need somebody else to help you with treatment of that severe hypoglycemia. And the treatment for severe hypoglycemia is typically one of two things, either an intravenous injection of glucose, which is something that takes place at the hospital, or a drug called glucagon. Remember I told you about the glucagon that comes from the pancreas to the liver to release glucose? Well it can be given until recently by injection. So when Robert and I started working on locemia, we were looking to address an unmedical need for an easy to use glucagon. This is the current or the formulation that was available at the time. You can see it's a prefilled syringe with a pretty large needle and a vial of dry powder. So in order to use this drug, a person would have to take the cap off the needle, insert it into the vial of dry powder, inject the liquid, mix it up, drive back out, get rid of the air bubbles, and then actually go give an injection with this pretty big long needle exposed. So what happens in real life is that people wouldn't use it to scary, scary procedure. And so people weren't carrying it, weren't using it, and unfortunately a really good drug wasn't being used and that's what we sought to address. Now Robert will tell you more about this when he gives you his background as a parent of two boys with type 1 diabetes. Now before I turn over to Robert, I want to give you a little bit of his background so he can continue straight on with the discussion at hand. So Robert is an American, has a business degree, sold computers in New York for IBM for about five years before moving to Montreal to marry Marla in 1987. He bought a small biosensing company in Montreal that he eventually merged with a company called AMG Medical for which he is still the chairman of the company. AMG Medical was importing and distributing a variety of durable medical goods. One day one of his business partners at AMG Medical, Big Al, brought forth a handful of landsets and said to Robert, people are starting to use these landsets to prick their fingers to do home blood glucose monitoring. Like it's a new thing that's being developed right now. I think there might be a business here. Robert ran with the idea and shortly thereafter created a new company that was selling private label diabetes supplies to US pharmacy chains. So what started with landsets ultimately became needles, syringes, glucometers, testing strips, glucose tablets for treating mild and moderate hypoglycemia in people diabetes who took to Kinsley. So Robert had in fact built a very nice business in diabetes when in 1997 his world was turned upside down and I'll turn over to Robert. Hello everybody. Thank you, Claude. So I had already been in the diabetes business for seven years as Claude had said and then in 1997 it was August in a span of less than a month our older son Corey who was age three at the time and a younger son Justin who was nine months old they were diagnosed with type one diabetes within a month of each other. And I'll tell you that you know for everyone who is diagnosed with diabetes and put on insulin type one or type two there's actually a second diagnosis that I refer to as the unspoken diagnosis. Nobody even refers to it as a diagnosis. It's the risk of hypoglycemia and of course the risk of severe hypoglycemia. This risk hangs over everyone like a constant dark cloud. It's a near term immediate potential complication. It's not long term. It can happen anywhere at any time and I refer to it sometimes as a plague. You know when people are diagnosed and put on insulin you think about and you go to Google and you read about long term complications. You read about things, the eyes, kidneys and this is immediate. This is at any time near term and I want to emphasize this. And it's not just the risk of the event. It's not just when it happens but it's the fear and the anxiety of hypoglycemia that affects all kinds of interactions that you have. As parents my wife and I were constantly thinking about who's got our kids backs. And I'd like to take a couple of minutes to share some insights including some of our inner thoughts about how we navigated life over those first 10 years from the time that our boys were diagnosed and put on insulin. Importantly I wanted to keep in mind that during the first 10 years that our kids were diagnosed and put on insulin the only option for teaching rescue to others was the complicated needle based glucagon kit that clode held up. So if you would with me envision that there were different groups of people who are very important to us and our boys. I'll start with teachers, first group of teachers, school nurses, babysitters, parents of kids of our friends and hockey coaches and in all of these cases we had to project ahead based on the personality of the individual we were going to have to speak with and teach how they might have to rescue one of our boys and how they might react to actually being taught about something so complicated. We thought about the timing of doing the teaching and its impact in every conversation and I'll use a hockey coach as an example. My wife Marla she taught so many school nurses, so many babysitters, so many teachers and there was anxiety in each example but the hockey coach we both had to consider and that's a unique example because we had to actually think about the timing you know whether we would tell the coach about rescue and their responsibility and role which they didn't sign up for they were just hockey coach. Whether we would tell the coach before our kids made the team or would we wait until after all the trials were over and then tell the coach and so there were subtleties in sharing this responsibility with another of what they would need to do in rescue. The grandparents different situation our boys had loving grandparents they still do but right or wrong my wife and I made a judgment call that it would be just too much of a burden for them to be trained on the glucagon kid and we might have been wrong on that but as a result of our judgment and our decision there the grandparents our kids had limited chunks of time with their grandparents we were typically always there at the same time or if they were alone with our kids it was a specific short period of time it wasn't there were no sleepovers and the idea of training grandparents on how to use a glucagon kid for a sleepover and for a severe low blood sugar that could happen at two in the morning it was just not something we wanted to do though the kind of one other example that is I want to paint a picture for you if I could is the college roommate you know as our older son got older he was heading towards his freshman year he had a roommate that knew he had diabetes and as we drove to school we knew that the roommate knew he had diabetes but we said to our son do you want to share about rescue about glucagon with your roommate or do you want us to share it do you want us to tell him what he would need to do with the glucagon kid and our son actually said you know what let me handle it I'll handle it and we we got to the school and we were moving him in and day one passed we asked our son whether he had had the conversation and he hadn't had it day two passed and by day three we were leaving and we were going to head back home to Montreal and we said to our son have you spoken to your roommate yet to teach him about glucagon and he said no I haven't done it yet and we knew why he didn't do it yet there's a whole process to doing it in the timing anyway he promised that he would do it and he did do it and and the roommate you know who had not signed up to become an EMS worker he he's very mature kid and he handled it well and fortunately our son never had a severe low that year or during college and and it would never have to be used but that idea of telling people who surround you and educating people it was really starting to hit home with me and I'll say that these personal experiences with my family led me to deeply understand the relationship between the risk of severe hypoglycemia and and situation avoidance dependence on others loss of spontaneity constant compromise increased anxiety and fear loss of confidence and and and vulnerability I had thought I had empathy during the early years that I was marketing glucose treatment products glucose tablets and gels and drinks to pharmacies across America but before my boys were diagnosed and before living through what I live through with my boys I I learned real empathy and I'll say that after 10 years of brewing and stewing on the horrible complexity of glucagon rescue and having put in the requisite 10 000 hours that Malcolm Gladwell wrote about in his book outliers I was ready to do something so that my boys could feel in their hearts that people could have their backs and that those who surround them could feel in their hearts whether it's a hockey coach or a grandparent or a college roommate that they could in fact have the backs of my two boys and I got to tell you I had no experience in pharma I had primarily sold over the counter products and medical devices but I wanted to do this but if if we were going to innovate glucagon for rescue purposes I needed to find a CEO with pharma experience who could lead what I envisioned to be a new mission focused company with a singular goal and that leads back to clode and I'll pass it back to clode okay thanks thanks Robert we'll go to the next slide please so um Robert and I were introduced to each other through a consultant named Dr. Alexander Fleming he goes by the name Zann Fleming former FDA medical reviewer endocrinologist and now for the last 20 plus years and one of the world's top consultants in development of diabetes products I'd known Zann for a few years and Robert I'd met him in his search for somebody and that's how we were introduced so in 2009 Robert and I started working together at the time I was still in Colorado I wrote a business plan well we wrote a business plan to try to innovate glucagon and as we were doing this Zann Fleming the guy who introduced us said to us one day well have you ever considered the intranasal route and we hadn't we've been thinking about a better injection a better way to inject that's that's where we are headed hey we after Zann suggested the intranasal route I did a literature search that night and lo and behold I found a paper published in 1983 by Dr. Ponte Roli from the University of Milan on intranasal glucagon to treat severe hyperbisemia in people then I found papers by Dr. Slama in Paris and a group of researchers in Denmark that you know together gave us quite a bit of data indicating that intranasal delivery of glucagon might be an interesting approach Robert and I actually flew to Milan to meet with Dr. Ponte Roli to Paris to Dr. Slama to Copenhagen to meet with some of Danish researchers and we came back convinced that the intranasal route was the way to go and so that became the basis of what we decided to do in 2010 I moved back to Montreal and Robert and I formed losemia solutions the company that we were building expressly to innovate glucagon for treatment of severe hyperbisemia we were able to recruit a very talented team of individuals in and around Montreal um losemia was always a virtual company we never had an office so for the losemia team working from home due to covid is simply a continuation of what we've been doing for a long long time we work with testing labs in the area we partner with cabs uh k abs in saint's bed to do our manufacturing we ran most of our clinical studies right here in Quebec although we also ran some in Ontario and in manitoba and in several states in the US one of the studies that we ran which has quite a Canadian flavor is what we call the nasal congestion study as we are delivering the drug through the nose an obvious question is what happens if I have a bad cold or a seasonal allergies seasonal allergies will the drug be absorbed so we actually started a study late one winter in Montreal where we had ads in the metro and ads on the radio basically saying if you've got a really bad head cold and you're really stuffed up you feel like awful we've got a study just for you and we managed to attract about 36 people who came in with a really bad head cold we dosed them while they were not feeling well had them come back a couple weeks later when they were fully recovered dosed them again and we're up to demonstrate that nasal congestion did not affect absorption of the drug anyway it's just one of the fun anecdotes for this one particular program eventually we were successful in completing phase one phase two and phase three clinical studies which culminated in the sale of the product Eli Lilly at the end of 2015 so I'll turn it back over to Robert and you could advance this slide you know it's funny like Claude summarized you know in less than five minutes this amazing journey we were on you can't imagine the twists and the turns and he summarized it with a happily ever after ending that the asset was sold to Eli Lilly but we had plenty of angst and sleepless nights along the way he mentioned the business plan we worked on which as you can imagine included extensive market research and consideration of other innovations in the diabetes field and I want to share with you a couple of old slides with images that came out of this market research that we did and ultimately became part of our fundraising pitch deck for telling our story to potential investors and when I look back at these images today in retrospect that remind me of the actual internal debate we were having with ourselves with ourselves literally with myself with each other and and also with advisors trusted advisors in evaluating whether to even embark on our journey to let's say muster up the courage so to speak of whether to do this so this slide that you see a long history of innovation in insulin you know since insulin was discovered there have been billions and billions of dollars invested by companies innovating insulin and also the devices used to deliver insulin we've gone from animal derived insulins to recombinant analog insulins in various you know long acting formulations fast acting formulations and we even have you know a few years back inhaled insulin and on the delivery side which is what you really see in this slide you see in the lower left we've gone from glass syringes which needed to be boiled to be sterilized and needles that needed to be sharpened to individually wrapped sterile disposable syringes featuring thinner and thinner needles over time to insulin pens and continuous insulin pumps the innovation has been impressive and I want for those who are watching this who might be in the diabetes space and say well you're not showing current technology modern tech and that's because this is an old slide and what's featured in this slide are products that are more than a decade old so none of the modern tech has depicted the if you would go to the next slide I'll make a comment here now so we have this history of innovation in insulin and insulin devices delivery devices but we had this long history of limited innovation in glucagon delivery and boy did we think about this we we had almost 50 years of of nothing when I say nothing we went from a cardboard box that you see on the left holding the components of the kit clothes showed you the plastic kit but before we had the plastic kit to kind of add insult to injury when the plastic like like you're seeing the kid on the left the box in the left two circles are actually my son's kit that I actually it was an expired kit that I pulled from his hockey bag and for years and years the kit in Canada was not even innovated to be the plastic kit that had been launched in the US we never got to the root of why that happened in Canada but we went all these years without innovation we're from the cardboard kit to a plastic kit but that's not innovation and so you might be wondering why this was and we spent countless hours wondering the same at the end of the day we concluded that there were several factors that hindered or you know one might say blocked innovation in glucagon and I'll share with you you know the total market for insulin was billions of dollars whereas the market for rescue glucagon was less than 150 million dollars at the time we were considering taking the risk glucagon innovation just wasn't attractive to be a priority for large pharmaceutical companies and in a way I don't blame the large pharmaceutical companies for this they were focusing on making better and better insulins for which my family is thankful so you know this is actually you know where small companies usually emerge to find innovative solutions to unmet needs and niche markets that are too small for big pharmaceutical companies but totally worthwhile for a more nimble company to pursue but yet it wasn't done and we wondered about that said are we missing something but in the case of innovating glucagon in talking to potential investors who were you know who we were talking to seeking funding for research for our research and development we quickly came to understand that they were totally spooked by the idea of investing in a project that had from their viewpoint double risk and what do we mean by that if we were going to proceed this was not just the development of a drug it was not just figuring out how to make a powder that could go on the nose it was the development of a medical device that would deliver the powder and and so we had double risk drug device combination risk and and and really investors they got spooked small market ignored by big pharma and I got to tell you all of that being said we felt compelled to take the risk because we felt that if we could overcome the technical hurdles the total address addressable market in fact would be many times the size of the existing market we felt that the market was so small because the the existing kit was so complicated or so I'll say bad and and if if the kit was simple and better more people would have it teach it and and and the market would expand so for us it was an important need for people using insulin but equally important I want to point out it was an important need for those who love or care for those who use insulin and so it was incredibly compelling to pursue this and we mustered up the courage with our own capital to get this started without I'll let you take you from there alright thanks for our next one more slide so our goal of those senior was really quite simple we're laser focused on simplicity we want to take treatment of severe hypoglycemia from a situation that's complicated and anxiety inducing to come a situation that's simple and where people are confident that they can do the job so next slide so that's where we developed vaccinee the nasal glucagon you can see here it's a really simple device it comes in a little plastic tube well protected you open up the plastic tube you pull out the device that device has got dry powder in it and it's a simply matter of inserting the tip into the nostril and it's literally a puff in the nose the drug is in absorb from the nasal mucosa and works essentially as rapidly as an injection so that's that was the product that we were able to develop now we did we developed a certain stage I'd like to throw some major kudos to Eli Lilly who took the asset from us in 2015 they did an amazing job of completing the development work of scaling up the manufacturer of obtaining regulatory approvals literally worldwide and finally launching the product in multiple markets despite the challenges associated with COVID-19 so we owe Lilly a big kudo and a round of applause for the work they have done and continue to do with our rescue device that we sold to them in 2015 so with that Robert I'll turn it back to you yeah this will get into what we really now we've set it up to tell you about what we really wanted to talk to you about today you know after we sold our nasa glucagon acid to Lilly in 2015 we were asked constantly about what we were going to do next and the answer to us was actually really quite clear after working so long for so many years in my case on on treatments for milder moderate glucose tablets glucose gels glucose drinks and then working on nasa glucagon after working on products to treat hypoglycemia we decided that we didn't necessarily want to or need to start another company doing something else but rather we decided to dedicate our efforts going forward to working with founders of other early stage companies focused on preventing hypoglycemia rather than treating it it's a bunch of time on treating it and and it'll take time to get to those products that prevented but some founders and there are many out there they need help and and we felt that each company even if they were working on just a tiny element of what would be part of a bigger ecosystem that we wanted to help them towards their goals of of preventing hypoglycemia and we'd like to use the remaining time with you tonight to highlight some of these companies and their founders that are working towards this mission of preventing hypoglycemia yet next slide so the next slide next up please so here we've got we're supporting several companies that are working on what's called automated insulin delivery or closed loop or hybrid closed loop or artificial pancreas systems these companies are using software to connect an insulin pump to a continuous glucose monitor and then using algorithms that calculate the trends in glucose levels and automatically control the amount of insulin being developed this photo represents a device being developed by a company called Beta Bionics a company that was founded by Dr Ed Damiano himself a diabetes dad he has a son of technical diabetes Beta Bionics is one of several companies that are developing automated insulin delivery systems next here's a photo of a system from a company called bigfoot biomedical you're seeing a cell phone a couple of special caps that go on insulin pens a glucometer and an automated and a continuous glucose center glucose sensor for the vast majority of people with type 2 diabetes who take insulin they do not use an insulin pump and give themselves insulin by injection for these people it's really difficult to know how much insulin they need to take as michelle referred to at the very beginning of the session tonight one company called bigfoot biomedical is introducing a new product that connects a special cap on the insulin pen to the continuous glucose monitor and using software provides on-the-spot guidance for insulin dosing now like Beta Bionics the company I referred to in the prior picture bigfoot biomedical was formed by three diabetes dads Lane Desborough a fellow Canadian here on this call Brian Maslitch and Jeffrey Brewer who is formerly the president of JDRF next image I'll speak to this one because this is a prototype of a new generation continuous glucose sensor can't really see the details of what makes it different to it's using micro needles that will allow the sensor to be I'll say I'll use the term pressed on but more easily applied and applied on other parts of the body different than today's phenomenal continuous glucose sensors we have spectacular continuous sensors today on the market but there will always be a next generation and biolink is a company that's working on the potential of a multi analyte sensor that uses these micro needles on the lower surface it's sitting on the finger there it's not because it's going to be applied to the finger it's sitting there to show you the context of the size of the sensor but if we can get to a sensor that provides information to algorithms more than just glucose but let's say glucose maybe lactate ketones and perhaps even cortisol that could even improve automated glucose or automated delivery of insulin and and also improve guided insulin delivery in the case of a company like Bigfoot this company and and the way this network works I was introduced to the founders of this company by Jeffrey Brewer the founder of biolink who said that Robert this is an amazing early technology too early for Bigfoot you should go down and see them in San Diego and I did actually with my wife and my younger son and we visited there together I'll go to the next image and the next image is an infusion set people who wear insulin pumps have to have the insulin infused and we need better infusion sets this particular infusion set is from a company called Capillary Biomedical and it is working the companies are working towards an infusion set that could last in the body longer seven days and not kink kinky is a huge problem with infusion sets and that would be yet another improvement for automated insulin delivery and preventing hypoglycemia clode you'll take it from there okay next next time so here I've got an image of an old insulin valve you'll see the relevance of that in just a minute but we're also working with several companies who are seeking to improve insulin since the insulin was discovered a hundred years ago we've there's been continuous effort to make insulin safer more effective easier to use we've been working with a company called Diasone Pharmaceuticals like locemia and Bigfoot and bit of ionics Diasone was also formed by a diabetes dad a man called Dr Blair Jiho and the company is now led by son Bob himself has type 1 diabetes so the company is working on an additive to insulin to make more of the injected insulin actually get to the liver this is an important thing that we think would make in their insulin a better insulin we're also working very closely with another startup called surf bio surf bio is working on novel formulations to make an ultra rapid acting injected insulin and also a room temperature stable insulin as is the case with the prior companies we've been discussing surf bio was formed by two diabetes parents both of whom also have spouses with type 1 diabetes finally in the insulin space I'll make comment about another company called Axton bio a Boston based company that is working to develop an ultra long acting insulin as well as what is referred to as a glucose responsive insulin this is an insulin that stays in the ejection site until blood glucose levels rise to a certain level so instead of circulating freely at all times it's only there when blood glucose levels go high so if they were to succeed in this we might finally have a truly safe insulin that would significantly reduce the risk of hypoglycemia next slide so one of the challenges associated with injection of insulin is the development of scar tissue at the injection site out of habit people tend to frequently inject in the same area for example a right handed person might take this range and frequently go into the left quadrant left lower quadrant of the abdomen that's fine but if you do it too often or over a long period of time you tend to develop kind of a scar tissue in the injected area and that scar tissue adversely affects the way insulin is absorbed you might get poor absorption therefore your glucose levels don't come down or you might happen to hit some a fresh meat area an area with good circulation and end up going to hypoglycemia now the only way to prevent that is to encourage people inject insulin to practice what's called injection site rotation where an insulin injections are spread out across different areas of the body now we've been supporting a small Montreal company that's come up with a really low tech idea to encourage people to inject to rotate their injection sites they put their pen needles four different colors in a box and you as an insulin user decide which color goes where so let's say you say blue for me goes in the buttock and green for me goes into the lower abdomen yellows and everything space and purples and other space so when it comes time for me to give an injection I go into the box and randomly pull out a needle oh it's the blue one that goes in the buttock next time I give an injection I pull out box agreement that's my lower left abdomen so I don't have to remember where I gave the last injection I just pull it out and go to the site associated with that color and it's giving me an injection site rotation scheme to produce complications finally the last the last image please is a company in Toronto called Zuchara Therapeutics they're working on a new medication that we hope will actually prevent hypoglycemia their medication hopes to restore the abilities the body's ability to secrete glucagon in the presence of low blood sugars interestingly here this company the new medication is the fruit of research of a doctor Michael Riddell a professor at York University in Toronto who is widely recognized as one of the world's leading experts in exercise and diabetes he also happens to have type 1 diabetes himself so we've given you a small sample of the kinds of things we're looking at and the kinds of entrepreneurs and companies are supporting with our mission of making a difference for people diabetes and as well as preventing hypoglycemia so I'll turn it back to Robert you're mute I was I was actually going to make some more comments I'm going to skip it because I want to leave time for questions um Claude and I have not presented in this way and told this story before about all the companies we're working with so we had no real clue on the timing of it if you could go to the next slide club maybe you'll take that one yeah okay well just we just want to show this last slide because some of you may not be familiar with this but this obviously is a Canadian $100 bill and that insulin violin $100 bill is the one we used in the prior slide uh for insulin so it's a it's a bill that came out in 2011 recognizing the discovery of insulin in Canada some hundred years ago although like I said the bill came out in 2011 um what we're not showing on this image is some of the other things that are associated with with baxemia those of you are interested in hearing a little bit more about how baxemia is being received in by by by patients and their caregivers you do go to instagram and do hashtag hashtag baxemia you'll read all kinds of stories of rescue and so on and Robert and I sincerely hope that the companies we're working with and others eventually have their own hashtags like hashtag bigfoot hashtag disome hashtag bio link etc so with that we'll stop there we've taken probably more time than we should have but we really appreciate the opportunity to speak with you and we'll turn it over back to Michelle well thank you so much Robert and Claude for sharing uh the story I love stories of innovation it fascinates me how you how these ideas are generated and where they come from so um I'm going to invite our audience to uh find the q and a button at the bottom of your screen um feel free to ask a question we've got about 15 minutes still that we can we can work through some questions coming in uh as those roll in I'm going to start with a question of my own um where did you get the name losimia from Claude why don't you take that one okay so so losimia is just to play on words that Robert came up with it's a combination of low blood sugar and hypoglycemia low semen that's where it comes from and then what about baxemia which so baxemia is another story um I said Robert came up with losimia he also came up with baxemia I can't tell you how many hours I spent in cars on airplanes in hotel restaurants hearing him come up with one name after another after another but the concept behind baxemia is really rooted in the concept of having someone's back I've got your back you've got my back I know I can help you in a serious situation and so back back became baq because back would probably never be allowed from a regulatory perspective in the name of of a drug but the baq sounds the same as back and the q refers to Quebec where most of the drug development efforts took place and in back see me the rest of the word is an add-on to complete the word but it's a name we came up with and we're thrilled that that literally decided to go with it the code the code name for the project which we don't think whatever I've gotten approved by the FDA but we loved was schnauzagon uh I have a big schnauz and schnauzagon was going to be the name but we went with a more pharmaceutical sounding name I mean I quite like schnauzagon I'm not gonna lie maybe people out in the market as long as people who love or care for insulin users learn about the product they can call it whatever they want for us it's about creating a wider net and I make a comment you know the people on this call tonight you've learned something we hope you've learned something and spreading the word and letting people know there is now a simpler rescue glucagon it means again that my kids can know that people could really have their back and those who love or care for people like my kids school teachers hockey coaches nurses babysitters other parents they can feel confident now that they can do this and and that creates a wider and wider network and the simplicity also enables a discussion it's just the mere fact that we're having this discussion we could have never had and talked about a glucagon kit for in this kind of a form because it was so scary before so we do say that that we think that simplicity has been a discussion enabler and the more discussion we have about rescue of people who use insulin the better the more prepareable people people will be on the topic of rescue how often does hypoglycemia occur like you said once or twice a week for kind of a milder moderate but what about a severe one so there's no the numbers on that very considerably depending on where you get them but you know we say on average people type one have one to three episodes per year people type two on multiple daily injections it's one or two per year but that number isn't really very meaningful because you have some people have five or 10 they're not aware that they're high that they have hypoglycemia and so they get like they don't they don't feel coming on anymore so the number isn't what's as important is what is it what the fear of hypoglycemia people on insulin are always afraid of the fear you know it's a fear of hypoglycemia which is really the hard part so the way we look at it should always be prepared we frankly hope that the kit expires because you should celebrate that you didn't have to use it but you had it in case you needed it what is the shelf life of it i i believe in Canada it's two years i'm pretty sure we'd have to double check with lily yes okay um are there any other considerations that you have to take into account with vaccinee like you talked about having a cold and that's good but what about people who have like asthma or sinusitis or like sensitivity in the nose or or anything like that well we haven't explored every single situation you know we know that the drug is indicated for people on insulin four years of age and above and nasal congestion associated with the cold doesn't have an effect it's not inhaled michelle it's absorbed from the nasal mucosa so asthma has no effect on this at all lung disease has no effect um you know would there possibly conditions of the nose that i'd be surprised i mean the the the nasal pastures have a rich vestature and a large surface area for absorbing medications so i don't think there's any specific things but we recommend people to take a look at the labeling consult with their doctor make sure that they're recovered on any potential contradictions i have a comment on that clotted and and we're talking to our canadian audience so we're pretty proud of the fact that in in the freezing freezing freezing tundra environment you know up way up north in edmonton calgary or wherever you want to go that that the powder won't freeze and so you know if you're skiing you're out on the lake you're playing hockey you're skating whatever we we've tested it i should say i can't make those claims lily would have to answer the the point at which it would freeze but i haven't seen that point clotted comments no same same yeah i expect for a powder it would be yeah it would be good for really low temperatures yeah yeah um so i'm going to ask you kind of a two-part question um so someone's asking about some of these timelines on the innovations that you were talking about um and i'm going to steal a part of that question that interests me specifically and that's about these these ai programs that you were describing that kind of predict when hypoglycemia might occur and take into account kind of some of these other um chemical circulating in the body and activities that are going on and such how good is that ai technology now like how good is it at predicting the highs and the lows and then modulating that so i'll i'll say this i'm i'm almost embarrassed to even try to answer this because i know one of the world's experts lane desperate is on this call if we could have lane answer that question that would be that's best for the entire laughing in the chat right lane you do us a big favor if you could just a pint on that maybe lane if you can type it in the chat perhaps and sitting on it in his undies by the pool well he's muted he's muted we have to mute him michelle you hopefully we'll have enough time for him to give a brief answer because it would be great well well our tech maybe works on getting him unmuted let's do a super quick question what is the price of vaccine me oh i think in canada it retails at 125 or 130 dollars at dokes if i recall but it's covered by private health insurance across the country and it's soon to be covered by our various provincial uh insurance ball and insurance programs like that i'm going to get back and there was a press release by illa lily about their progress in that regard with regard to access and you can just google back see me illa lily canada it was the last press release illa lily canada did it's just two weeks ago so we're excited about news that might come in the first quarter of next year lane's trying to give the answer i think i can talk now can you hear oh yes great uh so it's an excellent question and something that many companies have been trying to figure out for years what i would say is that predicting blood glucose in the future is extremely difficult i think probably the best we can expect right now for the conceivable of futures around 30 minutes ahead and part of this is because people do this crazy thing about three times a day called eating and eating is very hard to predict uh so when you eat how much you eat the content of the food you're eating is at a high glycemic index a low glycemic index does it have fat does it have protein so all of those predictions that you make through the course of the day kind of go out the window every time a meal arrives so what a slightly more nuanced answer is that overnight is much easier to predict blood glucose because the 42 things that are contributing to blood glucose variation aren't present the stress the exercise the hormones the the meals so it is more predictable at night but that's not when you need it that's not when you need the predictions so what i would say is it's a challenge people are working on it but predicted more than about half an hour into the future is pretty hard Lane can you make a comment though without predicting it how good the algorithms are in the closed loop systems today oh sure so a broad answer to that question that i think is supported by a lot of both clinical and real-world evidence is that people are able to achieve about 10 higher time and range from their status quo when they go on an automated insulin delivery system and so if they and by time and range i mean the time from in american units 70 to 180 milligrams per deciliter or in canadian units what about five to ten four and a half to ten millimoles so wherever you're starting from if you're a 40 time in range you can probably get 50 time in range and the reason why this is so variable is because people's behaviors are such an important determinant of what's going on with their blood glucose are they exercising are they in a stressful job are they going through puberty are they eating a lot or are they on a low-carb high fat diet are they very engaged with their diabetes or are they very busy with other aspects of their life so people are coming at time and range from a bunch of different places and perspectives but in general automated insulin delivery gets you about 10 higher than that michelle you should give lane's home phone number or cell number if people want to talk about i'm just joking lane we're out of time so michelle i can just ask you we are yes um we've got a few really good questions still in the chat here so i'm going to put you two on the spot right now and ask you if i can type up some of these questions and send them to you to answer as a written interview which we can post afterwards awesome that would be fantastic yeah so um with that uh i want to say a huge thank you to our guest speakers this evening mr robert oringer and dr clode pichet thank you for your time thank you for your passion and i think on behalf of millions worldwide thank you so much for the lifesaving treatment that you've made available to diabetic families worldwide to our audience i'd also like to say thank you for joining us and participating and for the questions that continue to roll in and the thank you so my last plug of the evening is if you did enjoy what you hear tonight uh you should tune in for our third and final talk in the series on beyond injections and that is occurring towards the end of march uh that's going to be lisa heppner who is the director and producer of a documentary called the human trial which you know we've talked about the history of diabetes and insulin we've talked about innovations in for insulin users and she's going to be talking about the potential for a cure so you know a world where we don't have to worry um about putting insulin in our bodies that doesn't come from our bodies which kind of is you know the ultimate the ultimate end game here so if you're interested in that check out our website uh sign up for our info lines um and yeah we hope to see you there so on behalf of myself on behalf of robert and clode and the science and technology museum and the ingenium foundation i'd like to say a sincere thank you to everybody and i hope you have a great night a great week a great holiday season and that you all stay healthy and stay well bye now thanks michelle thanks everybody good night