Types of Insulin Delivery Systems

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You need insulin to control your diabetes. But there are a few decisions you and your doctor still need to make, including how you take that insulin.

The options include pens, syringes, pumps, jet injectors, and an inhaler.

Choosing an Insulin Delivery System

People often make their choice based on what their health insurance will cover, says Vivian Fonseca, MD, professor of medicine at Tulane University School of Medicine.

Your insurance may only pay for one type of insulin delivery system. If you want a different option, you'll have to pay for it on your own.

Aside from your insurance coverage, your choice should be based on which system you feel most comfortable with, Fonseca says.

"There are people who handle syringes better than others," he says. "And while many do well with pumps, some patients either don't like them or don't manage to use them effectively."

Insulin Syringes

You use one of these to inject insulin into your body with a very fine needle.

Pros:

Flexibility. You can choose from different types of needles and syringes. You can also use them with just about any kind of insulin.

Cost savings. A box of 100 syringes costs about $10 to $15. They’re also more likely than other delivery systems to be covered by your insurance.

Cons:

Time. "The real problem with the syringe is the amount of steps you have to take," Fonseca says. Before injecting you need to fill the syringe with air, attach the needle, and draw the correct dose of insulin into the syringe.

Dosing mistakes. "The syringe is totally manual, and it possibly leads to more errors," Fonseca says. It's up to you to make sure you inject the right dose.

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Insulin Pens

These work much like a syringe, but they look like a pen you use to write. They come in disposable and reusable versions.

Disposable pens come pre-filled with insulin. Reusable models use a cartridge filled with insulin.

Pros:

Ease and convenience. To use, you just dial up the insulin dose on the pen. Then you press a plunger at one end to inject the insulin through a needle at the other end.

Memory storage. The memory feature will remind you how much insulin you took and when you took it.

Cons:

Expense. Insulin pens cost slightly more than syringes (about $30 - $40 a pen). Many insurance companies won't cover the cost.

Lack of options. Some types of insulin aren't available in pen form.

Insulin Pump

This device is about the size of a pager. You wear it on your belt or in a pocket. It delivers a steady stream of insulin to your body 24 hours a day through a needle attached to a flexible plastic tube. Whenever you eat, you press a button on the pump to give yourself an extra boost of insulin, called a bolus.

The pump is an option for people with type 1 diabetes who haven't reached their target blood sugar level using other delivery methods. Also, one large study concluded that the insulin pump is a safe and valuable treatment option for those with poorly controlled blood sugar, despite multiple daily insulin injections. It's also a good option for people with diabetes who have very active lifestyles.

Pros:

Steady insulin release. "The pump's advantages are linked to its very nature, which is to try to mimic the way the body makes insulin -- a small amount all the time and a boost at mealtimes," Fonseca says.

Pumps are so efficient that you can use less insulin than you would with a syringe or pen.

Easy to use. When you use a pump, you won't have to give yourself injections throughout the day. The pump delivers insulin to you automatically. You can also eat whenever you choose.

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Better blood sugar control. The pump helps prevent blood sugar swings because it supplies insulin steadily.

Easy to monitor. Your pump can communicate with your glucose monitoring system, so you can track your blood sugar over time and make changes to your routine as needed.

Cons:

Constant wear. "The disadvantage is that you are hooked to a device that your life is dependent on," Fonseca says. You're going to be attached to this pump nearly all of the time -- even when you sleep.

Risks. You must take care to change the needle every couple of days, because there is a slight risk for infection.

You also have to track your blood sugar levels, because you may be more likely to have a drop in blood sugar with the pump than with a syringe or pen.

If the catheter slips out or the pump fails, you might not get the insulin you need. Over time your blood sugar levels can rise, and you could get a dangerous complication called diabetic ketoacidosis.

Cost. Pumps run about $5,000, plus you have to pay for the ongoing cost of supplies (such as batteries and sensors). That adds up over time.

Jet Injectors

These don't have a needle. Instead, they use very high pressure to push a fine spray of insulin through the pores in your skin.

Pros:

Needle-free. If you hate needles, a jet injector is an alternative to the insulin syringe or pen.

Cons:

Pain. "They surprisingly may cause more pain than a needle in some people," Fonseca says. You have a high concentration of nerves close to the surface of your skin. Trying to push insulin through the skin can hurt more than injecting.

Uneven insulin delivery. Because they send insulin into the body through the pores, jet injectors may not always deliver an accurate dose.

Other options include an insulin patch. Work closely with your doctor to choose the option that best fits your budget, health needs, and lifestyle.

Inhaled Insulin

A rapid-acting inhaled insulin is approved by the FDA for use before meals.

Pros:

Timing. The drug peaks in the blood in about 15-20 minutes, researchers say, and clears the body in 2-3 hours.

Needle-free. Users place a dose of insulin, in powder form, into a small, whistle-sized inhaler. Doses come in a cartridge, and each cartridge contains a single dose.

Cons:

More insulin needed. Inhaled insulin can be used for both type 1 and type 2 diabetes. But people with type 1 diabetes must use it combination with long-acting insulin.

Risks. You should not use inhaled insulin if you smoke or have chronic lung disease. So before you start on this type of insulin, your doctor may give you some lung tests.

WebMD Feature Reviewed by Michael Dansinger, MD on May 14, 2015

Sources

SOURCES:

Vivian Fonseca, MD, FRCP, professor of medicine, endocrinology Section Chief, Tulane University School of Medicine; president of Medicine & Science for the American Diabetes Association. (Disclosure: Fonseca consults with and conducts research for many of the companies that make and market insulin and insulin delivery systems, including Eli Lilly, Novo Nordisk, and Sanofi-aventis.)

American Diabetes Association: "Insulin Routines."

American Diabetes Association: "Advantages of Using an Insulin Pump."

American Diabetes Association: "Disadvantages of Using an Insulin Pump."

American Diabetes Association: "Insulin Pens." 

Rakel, R. Textbook of Family Medicine, 8th ed., Saunders Elsevier, 2011.

Nitesh, S. World Applied Sciences Journal, 2010.

News release, FDA.

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