Overview
Reviewed by Deborah Wexler, MD
Many people who take insulin to manage their diabetes inject the insulin with a needle and syringe that delivers insulin just under the skin. Several other devices for taking insulin are available, and new approaches are under development.
Detailed Description
Reviewed by Deborah Wexler, MD
Many people who take insulin to manage their diabetes inject the insulin with a needle and syringe that delivers insulin just under the skin. Several other devices for taking insulin are available, and new approaches are under development.
Injection aids are devices that help users give injections with needles and syringes through the use of spring-loaded syringe holders or stabilizing guides. Many of these aids use push-button systems to administer the injection.
Insulin pens can be more convenient than carrying insulin. They can be more discreet and can make it easier to measure the correct dose of insulin. An insulin pen looks like a pen, but it contains a cartridge of 300 units of insulin instead of ink. Some of these devices use replaceable cartridges of insulin; other pen models are disposable. A short, fine needle similar to the needle on an insulin syringe is screwed on the tip of the pen each time the pen is used. Users turn a dial to select the desired dose of insulin and press a plunger on the end to deliver the insulin just under the skin.
Insulin jet injectors send a fine spray of insulin through the skin by a high-pressure air mechanism instead of needles, but they are not as commonly used.
Subcutaneous infusion sets, also called insulin infusers, provide an alternative to injections. A flexible hollow tube called a catheter is inserted into the tissue just beneath the skin and remains in place for several days. Insulin is then injected into the infuser instead of through the skin.
External insulin pumps are devices that deliver a continuous infusion of insulin. Most use narrow, flexible plastic tubing that ends with a needle inserted just under the skin. One uses a reservoir that is attached to the skin, but is not attached to the pump. The insulin pump is about the size of a deck of cards, weighs about three ounces, and can be worn on a belt or carried in a pocket. Users set the pump to give a steady trickle or "basal" amount of insulin continuously throughout the day. Pumps release "bolus" doses of insulin (several units at a time) at meals and at times when blood glucose is too high based on the program set by the user. Pumps can also be programmed to release different amounts of insulin at different times throughout the day and night. Frequent blood glucose monitoring is essential to determine insulin dosages and to ensure that insulin is delivered. Patients with type 1 diabetes who use insulin pumps are at higher risk of diabetic ketoacidosis if the infusion is interrupted.
Approaches Under Development
Inhaled insulin is breathed through the mouth into the lungs, where it is absorbed. Inhaled insulin is not always absorbed predictably; one inhaled insulin product was discontinued, but others are under development.
Implantable insulin pumps are surgically implanted under the skin of the abdomen. The pump delivers small amounts of insulin throughout the day and extra amounts before meals or snacks. Users can control doses with a remote control unit that prompts the pump to give the specified amount of insulin. The pump is refilled with insulin every two to three months.
The insulin patch is an adhesive patch designed to be placed on the skin. It provides a continuous low dose of insulin. Because it's difficult to overcome the skin's barriers, delivery of insulin through the skin is aided with sound waves or an electrical current.
Insulin pills provide insulin in tablet form. Researchers are working on ways to get the insulin into the bloodstream before it is changed by normal digestive processes.
Researchers are also investigating delivering insulin as a spray. A buccal spray delivers liquid insulin into the mouth. Insulin is then absorbed through the tongue, throat, and inside of the cheeks. An intranasal spray delivers insulin as a nose spray.
An artificial pancreas, a surgically implanted device, imitates the action of the pancreas by sensing blood glucose levels and secreting insulin, and possibly glucagons, in response. The user also can release insulin using a remote control.
Islet cell or pancreatic transplant is an option for insulin replacement for people who have already had an organ transplant and already take medicines that prevent rejection of the transplanted organ.
Take Action
To find out more about whether alternative insulin devices could be right for you, ask your doctor the following questions:
• What alternative insulin devices have you recommended for your patients?
• What are the positive and negative sides to the devices you have used?
• Do I need to be particularly concerned about any risk factors on the basis of my personal medical history?
• Will this device be covered by my insurance? If not, is there another way to offset the cost of this device?
You may also wish to consult more than one doctor and compare notes with each.
Last updated: 19-Dec-07
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