Types of Insulin Delivery Systems for Diabetes Management

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: Thank you for joining this Peers and Perspectives presentation titled, “Advances in Insulin Delivery Systems.” I am Diana Isaacs, an endocrine clinical pharmacy specialist, and the remote monitoring program coordinator at the Cleveland Clinic Diabetes Center. Joining me today is Natalie Bellini, a nurse practitioner specializing in diabetes management with the R&B Medical Group in Williamsville, New York. Welcome, Natalie.

Natalie Bellini, DNP, FNP-BC: Hi, Diana. Thanks for joining us, everyone.

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: Today, we will discuss insulin delivery methods, focusing on inhaled insulin, its pharmacologic properties, and data on glycemic control in type 1 diabetes. We will also discuss the use of inhaled insulin in type 2 diabetes and emerging data on oral insulin as well as other insulin delivery options. Thank you so much for joining us, and let’s go ahead and dive right into our content. Natalie, I’m going to throw this first question to you, and I’m wondering if you can give us an overview of the types of insulin delivery methods that are available to use in type 1 and type 2 diabetes.

Natalie Bellini, DNP, FNP-BC: Thanks, Diana. There are a lot of different ways to get insulin in, aren’t there? The first way that we use a lot, especially at the beginning of a diagnosis, are insulin pens or injections. There are a lot of different insulin pens on the market; they’re similar, but each one is a little bit different. Insulin syringes are also used with lots of patients. Another way is…connected pens or pen caps, and those pens work with an app on a phone and, sometimes, even with a continuous glucose sensor. It helps the patient remember when to take their insulin, remember how much to take, or even help them to calculate out the dose that they’re going to take depending on the brand and what they’re using. Then, there’s inhaled insulin, which is used for both mealtime as well as corrective insulin, and is inhaled through the lungs. We have patch pumps or wearable insulin delivery systems. One is called V-Go, and it is dosed in 20, 30, or 40 basal units a day…a patient presses a button, and they get 2-unit increment delivery from that. There’s also the secure insulin pump patch that is worn for 3 days. It delivers just the bolus insulin, and the patient gives basal insulin on the side on a daily basis. There’s the i-Port injection port, which is a patch that is worn and a patient injects into the port for up to 3 days’ use, and they can deliver bolus insulin via that. Finally, there are insulin pumps, and there are different pumps on the market that do different things. Some pumps are connected to a CGM [continuous glucose monitor] and some can suspend basal delivery. Some pumps can add basal when…the blood sugar is expected to increase, or take it away when it’s supposed to decrease. Those are called automated insulin delivery pumps. That’s the basics of what’s available on the market. It’s a lot of different things, and it’s hard to keep track of it all.

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: There are a lot of different options that we have available. Why is this so important, and why do we have so many options? More than ever before, there are a lot of people with diabetes. Based on the latest estimations, in the United States, over 11% of the population has diabetes. We know that most of those have type 2 diabetes and about 5% to 10% have type 1 diabetes. Type 1 must be on insulin and 100 percent needs a basal and a bolus insulin, but with type 2 diabetes, although there are lot of other great medications, a person will need insulin to be able to get to their glucose targets based on the natural progression, especially because we are seeing people diagnosed with type 2 diabetes much earlier in life—during their 30s, 20s, and even in childhood. If someone had type 2 diabetes for 20 to 40 years, a lot of times, insulin is required to be able to manage the condition. So, this is relevant, and it’s good that we have options.

Transcript edited for clarity