New Delivery Devices Make Taking Insulin Easier
By Hope Warshaw
Technology has improved insulin delivery devices, which has made managing glucose levels easier. Yet most people who take insulin continue to use a syringe or traditional pen. Talking to your healthcare provider about these devices could make it easier to dose your insulin.
Nearly 8 million people in the United States (roughly 1.5 million with type 1 diabetes and six million with type 2) require insulin to manage their glucose levels.
Technology and innovation over the last few decades has enabled the availability of a number of insulin delivery devices that aim to ease the challenges and burdens of taking insulin. Devices run the gamut from simple patches to automated insulin delivery (AID) systems. Nonetheless, more than half of the people who use insulin continue to use a bottle of insulin and a syringe or traditional insulin pens.
Taking insulin can be burdensome
Taking insulin every day, several times a day, is no easy feat, and the challenges fall into several areas:
Remembering 24/7 everything about taking insulin, including when it’s working hardest (at peak), and everything about food, from times of meals to amounts and types of foods consumed.
Doing the mental math to calculate insulin doses and the carbohydrate content of meals.
Recording and tracking all the data.
Analyzing the data to make adjustments on your own and/or with a provider.
It’s a lot to manage on top of doing life!
Newer insulin devices
Enter newer insulin delivery devices. These devices range from simple patches to insulin pumps automated insulin delivery (AID) systems, the latter representing the most sophisticated systems available.
Here’s a synopsis of the newer categories of devices and what they do:
Simple patch: Two products are available. CeQur Simplicity is a three-day wearable disposable patch used for mealtime (bolus) and correction doses. V-Go is a one-day wearable patch that is used to cover both mealtime and basal (background) insulin needs. Both offer discreet and convenient insulin dosing.
Connected insulin pens: These are sometimes called “smart” insulin pens because they can track insulin doses, give reminders, and more. Plus, they can connect with a continuous glucose monitor (CGM), which means they make it easier to access and analyze diabetes data.
Bigfoot Unity Diabetes Management Program has three components – two smart pen caps (one for each type of insulin), an integrated CGM, and a mobile app. To access this product the person’s healthcare provider must offer the product and support system.
InPen from Medtronic is a durable pen that uses prefilled cartridges of rapid-acting insulin. It integrates with Medtronic Guardian Connect CGM or Dexcom G6 CGM. The pen wirelessly transmits data that is accessed with the InPen Insights app.
Insulin pump and pod systems: These systems connect a wearable insulin pump or pod with a CGM. Through years of engineering, researchers have created smart algorithms that allow several of these systems to automatically adjust insulin based on glucose readings from the CGM. These systems include Insulet’s Omnipod 5, Medtronic’s MiniMed 770G, and Tandem’s t:slim X2 with Control-IQ.
Inhaled insulin: Only one product, Afrezza, is available that uses a prefilled single-use dose cartridge of ultra-rapid-acting insulin in an inhaler device. It is used for mealtime (bolus) doses and is typically paired with long-acting insulin.
Low tech use dilemma
Why do less than half of people who take insulin use one of these newer devices? This may be due to lack of access, by choice, or lack of awareness and knowledge about these newer devices.
Some people only use long acting basal insulin once per day and may not choose to use one of these newer insulin delivery devices to deliver their basal insulin. However, others who take multiple daily injections of insulin (typically one to two shots of basal insulin and three or more shots of rapid-acting insulin) may benefit from one of the newer devices.
The caveat is that it takes time and effort for primary care providers to understand and become familiar with the newer devices. “Let’s face it, today the majority of people with diabetes are cared for by primary care providers who don’t focus solely on counseling and caring for people with diabetes,” said Natalie Bellini, an Endocrine Nurse Practitioner and Certified Diabetes Care and Education Specialist, with a focus on diabetes technology, at R&B Medical Group in Buffalo, NY. “It’s a challenge for these providers to stay up to date on these devices and be comfortable with their use.”
Teaching people how to use the data, particularly from devices connected to a continuous glucose monitor (CGM), is time consuming, and seeking insurance coverage can drain many hours for both providers and people with diabetes or caregivers.
Jennifer Okemah, a registered dietitian nutritionist and certified diabetes care and education specialist and owner of Salute Nutrition in Seattle, WA, said that some people prefer to stick with their existing approach because they are familiar and comfortable with it.
“Sometimes I find people who are on an older device [who are] reluctant to change because they know how to use that device and are comfortable with it, even though their care could be easier with a more advanced device,” she said.
This “if it ain’t broke, don’t fix it” attitude may also explain why a provider doesn’t recommend a new insulin delivery device. Other reasons people may not want to change devices are: the time and energy required to learn how to use a new device, they don’t want to wear a device, or they’ve had a prior problem with a device and are hesitant to try another.
Ask your care provider about new technology
Ideally, all diabetes care providers could take time to ask people about their individual challenges and use shared-decision making to decide if a newer insulin delivery device is right. But that isn’t always the case.
“For better or worse, the responsibility to advocate for an insulin delivery device you want to use will fall to you or your caregiver,” says Okemah, who suggests you “take the bull by the horns.” Get to know and stay abreast of the innovation in insulin delivery devices (see go-to resources below). With knowledge in hand, initiate dialogue with your care providers using these tips:
Be upfront about the specific challenges you have with taking insulin and why you think a specific insulin delivery device may be helpful.
Contact your health insurance plan in advance of a discussion with your health care provider to determine coverage, cost and other particulars.
Do your homework and share your findings. Bellini suggests, “Access reputable sites on the internet, such as one of the sites listed below, and/or contact the manufacturer to ask questions, obtain further product information or get the contact for a local sales representative.”
Request your provider’s input and guidance. However, Okemah raises a red flag to note, “If your provider steers you to one and only one product, this may mean that’s the product(s) they’re comfortable with and not necessarily the best fit for you.”
Once you’re using the device, bring data output (if available) to your appointments or regularly send the data to your provider. Complete some preliminary analysis on your own. Have your observations, questions and potential next steps ready to share.
Do your research
Here are a few reliable go-to resources:
Danatech from the Association of Diabetes Care and Education Specialists (ADCES). Previously a members-only resource, this platform is now open to everyone. While some information on danatech is geared toward providers, there’s plenty of details for people with diabetes about the newer devices, infusion sets, apps and more.
DiabetesWise is a source for “Helping You Find The Right Diabetes Devices For Your Life” It’s an initiative from Stanford University School of Medicine and people with diabetes with support from the Helmsley Charitable Trust. DiabetesWise recently launched a provider side that you can recommend to your provider.
Panther Program - Diabetes Technology Deciphered. This website, at the Barbara Davis Center for Diabetes at the University of Colorado, offers information for health care professionals.. However, you’ll find helpful resources including AID system device comparison charts, tips for device placement, skin solutions and more.
Ask your primary care provider for a referral to an endocrinologist, diabetologist and/or a certified diabetes care and education specialist (CDCES). Most are familiar with insulin delivery devices and related technologies. They can consider your goals and desires, guide you in a device decision, help get you started on the device and assist you in fine-tuning the device to optimize your diabetes care.
Over the years, your wants and needs in how you deliver insulin and manage your diabetes will evolve. Technology and innovation have produced an ever-evolving array of devices to help you improve your glucose management and relieve some of the burden of taking insulin. People with diabetes who take insulin should rely on the resources discussed here to help them explore their options and advocate for their use with their health care providers.