Insulin Delivery
5/4/16
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When people eat sugars and starches, the body breaks them down into glucose with the help of insulin, the hormone that gets glucose from the bloodstream into the cells of the body to be used as energy. However, for people with Type 1 diabetes, this process cannot happen without manually giving insulin subcutaneously, since the pancreas, (the organ that produces insulin) stops doing so. Insulin must be injected and infused into the layers of fat under the skin.

There are quite a few different ways to deliver insulin, each with pros and cons, and it is up to the person with Type 1 and his or her doctor to decide what will work best.

 

Syringes

How it works:

  • Before anything, it is important to wash your hands and clean the skin with alcohol.
  • You’ll first need to uncap the needle of the syringe.
  • Pull the plunger to fill the syringe with air.
  • Insert the needle of the syringe into the vial of insulin.
  • Draw the plunger until the appropriate dose of insulin is inside the syringe barrel.
  • Holding the syringe upright, tap the syringe to release any air bubbles that may have collected in the barrel.
  • Next, insert the needle into the skin using your index finger or thumb and push the plunger down until all the insulin has emptied from the barrel.
  • Re-cap needle and dispose of in a secure sharps container.

How long it lasts: For one-time use and should be disposed of immediately following use into a sharps container

Cost: $10-15 per box of 100. Price may vary based on insurance coverage.

Pros: You don’t have the burden of a device attached to you.

Cons: You have to carry syringe supplies and vials of insulin with you, and make sure you don’t forget any of the steps involved in drawing up a dose of insulin. (A vial of insulin at room temperature should only be used for 28 days from opening, and must be disposed of after this time, even if there is insulin left over.) This can result in wasted insulin.

 

Pens

How it works:

  • Prepare and clean the skin with alcohol wipes.
  • Uncap the pen.
  • Attach the pen needle.
  • Dial up the dose using the dial on the end of the pen opposite the needle.
  • If using a pen for the first time, prepare the pen by first drawing in a very small dose of insulin and then pushing it into the air.
  • Insert needle into skin and push in the end to administer insulin.
  • When done, remove pen needle and dispose of in a secure sharps container.

How long it lasts: Some pens are disposable, others have replaceable cartridges of insulin that can be inserted into the pen. Once opened and stored at room temperature a pen is good for 28 days before it must be replaced.

Cost: Varies drastically depending on the insulin you are using, the pen brand and your insurance; $20-70 per box of 100 disposable needles (costs varies depending on gauge of needle).

Pros: Their small size and likeness to ink pens makes insulin pens a convenient and discreet way of carrying insulin. They’re often less painful than syringes because of smaller needles.

Cons: The pen needs to remain in the skin slightly longer than a traditional syringe injection, about 5 seconds after the plunger has been released. Pens can also be easy to lose or forget.

 

Pumps

How it works:

  • Pumps are small, computerized devices that deliver fast or short-acting insulin 24 hours a day through a catheter placed under the skin.
  • They deliver insulin consistently over a 24 hour period in the form of basel doses, and after eating or to correct a high BG you “bolus” to administer the insulin.
  • Many pumps have algorithms so you can put your Insulin:Carb ratio, correction factor, target BG levels and insulin sensitivity into the pump.
  • The pump will then help you calculate how much insulin to administer based on your blood sugar or carb count. However, you can also “bolus” manually without the use of the pump calculator.
  • Some pumps are now integrated with CGM technology, though this is not yet as common.

How long it lasts: The pump holds a small cartridge of insulin that usually needs to be replaced every 3 days depending on the individuals insulin needs. The pump site, aka the ‘catheter’, must be changed every 3 days to avoid bruising, insulin buildup and scar tissue. The actual pump devices typically last 4-5 years, but many will still work after their warranty has expired.

Cost: $4,500-6,500 without insurance.

Pros: You don’t have to individually stick yourself with a needle every time you need to inject insulin, instead you only have to use a needle once every three days to insert the catheter. Pumps deliver insulin more accurately than injections, as they have smaller dose increments.

Cons: Pumps can be expensive, even with insurance. The idea of wearing a device 24/7 can be off-putting for some people, especially if it is a pump with a cord. Pump sites can be ripped out accidentally, and there is always the possibility of the pump malfunctioning.

 

Inhaled insulin

How it works:

  • Inhaled insulin is used as a mealtime insulin, designed specifically to lower blood sugar spikes that can happen after you eat.
  • It claims to work faster than traditional injected insulins.
  • Using an inhaler similar to those used for asthma, you breathe a fine insulin powder into your lungs.
  • The insulin then enters your blood through small blood vessels.

How long it lasts: Once opened, the inhalers can be used for up to 15 days.

Cost: Afrezza, currently the only inhaled insulin approved by the Food and Drug Administration, may be covered by your insurance. Check with your provider for exact costs. Afrezza’s website offers an option to sign up for a $0 co-pay on your first prescription. There is also a saving program.

Pros: No invasive needle injections means no pain!

Cons: You’ll still need to take long-acting insulin to monitor your blood sugar. Additionally, side effects include a cough and throat irritation, and sudden lung problems have been seen in patients with asthma. It is not known if Afrezza is safe and effective in children under 18.

 

Medtronic i-Port

How it works:

  • The i-Port is a small device intended for people who use a syringe or pen to deliver insulin.
  • It combines an injection port and inserter to make for a quick insertion of the device, which leaves a small soft plastic cannula under the skin.
  • Syringes or pens are then inserted into the port every time an injection is needed, which drastically reduces the amount of pokes per day.
  • Similar to a pump site, the i-Port must be changed every 3 days.

How long it lasts: The i-Port can be worn for up to 3 days.

Cost: $96 per box of 10

Pros: You can wear it while you shower, bathe and exercise. It drastically reduces the amount of needle pokes into the skin, allowing for less pain. It is great for kids or those not comfortable with needles.

Cons: Infection, irritation or inflammation can result from improper cleaning of the skin prior to application. Must be changed every three days.


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