Diabetes Treatment (cont.)
Different methods of delivering insulin
Not only is the variety of insulin preparations growing, so are the methods
for administering insulin.
Pre-filled insulin pens
In the past, insulin was available only in an injectable form that involved
carrying syringes (which a few decades ago were made of glass and required
sterilization), needles, vials of insulin, and alcohol swabs. Needless to say,
patients often found it difficult to take multiple shots each day, and, as a
result, good blood sugar control was often compromised. Many pharmaceutical
companies are now offering discreet and convenient methods of delivering
insulin.
Both Novo Nordisk and Lily have an insulin pen delivery system. This
system is similar to an ink cartridge in a fountain pen. A small pen-sized
device holds an insulin cartridge (usually containing 300 units). Cartridges are
available in the most widely used insulin formulations, such as those listed in
the table above. The amount of insulin to be injected is dialed in by turning
the bottom of the pen until the required number of units is seen in the
dose-viewing window. The tip of the pen consists of a needle that is replaced
with each injection. A release mechanism allows the needle to penetrate just
under the skin and deliver the required amount of insulin. The cartridges and
needles are disposed of when finished and new ones simply are inserted. In many
cases, the entire pen is disposed of. These insulin delivery devices are less
cumbersome than traditional methods.
Insulin pump
The most recently available advance in insulin delivery is the insulin pump.
In the U. S., MiniMed, Deltec and Disetronic market the insulin pump. An insulin
pump is composed of a pump reservoir similar to that of an insulin cartridge, a
battery-operated pump, and a computer chip that allows the user to control the
exact amount of insulin being delivered. Currently, pumps on the market are
about the size of a pager or beeper. The pump is attached to a thin plastic tube
(an infusion set) that has a cannula (like a needle but soft) at the end through
which insulin passes. This cannula is inserted under the skin, usually on the
abdomen. The cannula is changed every two days. The tubing can be disconnected
from the pump while showering or swimming. The pump is used for continuous
insulin delivery, 24 hours a day. The amount of insulin is programmed and is
administered at a constant rate (basal rate). Often, the amount of insulin
needed over the course of 24 hours varies depending on factors like exercise,
activity level, and sleep. The insulin pump allows for the user to program many
different basal rates to allow for this variation in lifestyle. In addition, the
user can program the pump to deliver additional insulin during meals to cover
the excess demands for insulin caused by the ingestion of carbohydrates with the
meal.
Over 50,000 people worldwide are using an insulin pump. This number is growing dramatically as these devices become smaller and more user-friendly. Insulin pumps allow for tight blood sugar control and lifestyle flexibility while minimizing the effects of low blood sugar (hypoglycemia). At present, the pump is the closest device on the market to an artificial pancreas. More recently, newer models of the pump have been developed that do not require a tubing, in fact - the insulin delivery device is placed directly on the skin and any adjustments needed for insulin delivery are made through a PDA like device that must be kept within a
6 foot range of the insulin delivery device, and can be worn in a pocket, kept in a purse,
or on a tabletop when working.
Probably the most exciting innovation in pump technology is the ability to use the pump in tandem with newer glucose sensing technology. Glucose sensors have improved dramatically in the last few years, and are an option for patients to gain further insight into their patterns of glucose response to tailor a more individual treatment regimen. The newest generation of sensors allows for a real time glucose value to be given to the patient. The implantable sensor communicates wirelessly with a pager-sized device
that has a screen. The device is kept in proximity to the sensor to allow for transfer of data, however, it can be a few feet away and still receive transmitted information. Depending on the model, the screen displays the blood glucose reading, a thread of readings over time, and a potential rate of change in the glucose values. The sensors can be programmed to produce a "beep" if
blood sugars are in a range that is selected as too high or too low. Some can provide a warning beep if the drop in blood sugar is occurring too quickly.
To take things one step further, there is one particular sensor that is new to the market that is designed to communicate directly with the insulin pump. While the pump does not yet respond directly to information from the sensor, it does "request" a response from the
patient if there is a need for adjustments according to the patterns it is programmed to detect. The ultimate goal of this technology is to
"close the loop" by continuously sensing what the body needs, and then
responding by providing the appropriate dose of insulin. While this technology
is a few more years in the making, the strides in this direction continue to
grow.
Next: Inhaled Insulin »
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