Insulin delivery options now and later for type 2 diabetes
New insulin infusion technology is coming to improve the quality of life and outcomes for type 2 insulin users. They fill in a niche between insulin pens and pumps because these disposable products have one basal rate set by the manufacturer and prescribed by the doctor, for the time they are worn. Where traditional pumps allow far more precise increments of bolus insulin, delivering fractional units of insulin, patch pumps provide bolus insulin in increments of 2 full units at a time.
Alert dLife readers may have seen these patch pumps in the Gadgets and Gizmos slideshow. Some of these new devices are available now, while others are in still in development.
These new devices are designed specifically for type 2 patients. They are about the size of credit card but thicker. They are worn on skin under clothing, used to deliver insulin for a day or days and then are disposable. For many, this technology might be more comfortable than a syringe and preferable as they are hidden from view.
People using traditional insulin pumps, typically type 1s, often value the convenience of simply pushing a button to bolus. This convenience and the ability to easily scale the amount of insulin delivered to accommodate variety in meals are pump benefits now delivered by these new devices to people with type 2 diabetes. The convenience, comfort, and discretion of infusing insulin can enhance quality of life for people with diabetes.
In a Diabetes Care article, Rubin Peyrot says that many people with type 2 skip insulin injections in part because of the pain or embarrassment of shots. These new patches can help decrease both. This makes them a good option for many to consider with their care professionals.
In a recent dLife column, Wil Dubois wrote that for many taking insulin is a normal course of the progression of type 2 diabetes. Using insulin is not failure. As he points out, insulin is not a short coming in the character of a person with diabetes. It is just a the decline in their body's ability to make the insulin.
Think of these patches as insulin pens that have been flattened out and are attached with peal off adhesive tape. Insulin is stored in a small tank in the device. When a patient needs to take insulin for a meal they squeeze a delivery button for a number of times depending on the amount of insulin they wish to take. The insulin is then delivered by a small tube place through the skin called a cannula. Some of the devices also provide a constant slow delivery of insulin to cover the basal needs. Many people with diabetes currently use a slow-acting injection to cover their basal needs.
Here is a quick summary of some of these devices, their features, regulatory status, and market availability.
- V-Go is made by Valeritas, Inc. of Bridgewater, New Jersey. This device has FDA approval for adults with type 2 diabetes. Worn for a 24-hour period, V-Go users can receive both meal time bolus and continuous basal insulin. Three variations are available to cover different individual basal insulin needs at 20, 30 or 40 basal units per day. Bolus insulin is delivered at the rate of two units per button press. The cannula is metal. For more information visit: https://www.go-vgo.com.
- Finesse is a product of Calibra Medical, which was acquired by Johnson and Johnson in 2012. The device has been approved by the FDA, but is not yet being marketed. It will deliver only meal-time, bolus, insulin. A soft cannula is inserted under the skin and insulin will be delivered at the rate of two units per button press. The expectation is it can be worn for up to three days. Calibra does not yet have a website, but readers interested in learning more can see diaTribe: http://diatribe.us/issues/45/new-now-next/3.
- CeQur of Monteux, Switzerland is developing the PaQ. It recently received the CE mark of regulatory approval in Europe, but is not yet being marketed there. PaQ has not been through the FDA process in the United States. An application is anticipated. Wearable for up to three days, the device will deliver both bolus and basal insulin. Basal insulin will be delivered at rates of 16, 20, 24, 32, 40, 50, or 60 units per day. The cannula is soft and the PaQ can hold up to 330 units of insulin. More information about CeQur is available at: http://www.cequrcorp.com.
With patches, like all insulin delivery devices, there is a risk of high and low blood sugars. All medical devices should be used only with appropriate professional medical supervision and training. Your diabetes may vary. So should your options to manage it.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
- Peyrot M, Rubin RR, Kruger DF, Travis LB. Correlates of insulin injection omission. Diabetes Care 2010;33:240-5. (Accessed 05/13)
- dLife. Insulin. http://www.dlife.com/diabetes/insulin/wil_dubois/insulin. (Accessed 05/13)
- V-Go. https://www.go-vgo.com. (Accessed 05/13)
- Valeritas, Inc., https://www.valeritas.com/news-room/newsletter1. (Accessed 05/13)
- DiaTribe. http://diatribe.us/issues/45/new-now-next/3. (Accessed 05/13)
- PR Newswire. http://www.prnewswire.com/news-releases/calibra-gains-fda-clearance-to-market-finesse-insulin-patch-pen-for-three-day-use-with-novolog-99225574.html. (Accessed 05/13)
- CeQur. http://www.cequrcorp.com. (Accessed 05/13)
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