Diabetes keeps your body from using insulin correctly -- or in the case of type 1 diabetes, making insulin.
Insulin treatments can control your diabetes safely and easily. They can also give your body the blood sugar levels you need to stay healthy.
You can’t take insulin as a pill. If you did, your body would digest it before it could get to your blood. So you have to put it right into your bloodstream.
The most common devices for this are:
But which is right for you?
Most people make their decision based on the needle, says Janet McGill, MD, professor of medicine at Washington University in St. Louis.
In reality, McGill says, the needle should be a small part of the decision. It’s more important to think about how your treatment will fit into your daily life.
“You have to consider things like your social discomfort or ability to give yourself insulin at the right time,” McGill says.
Here’s a breakdown to help you decide which device is best for you.
How it works: A syringe is a thin, hollow needle connected to a chamber with a plunger. You draw up the amount of insulin you need from a vial, insert the needle into the fatty part of your skin, and push the plunger.
Pros: Got a tight budget? A syringe is your best bet. “It's the cheapest of the devices, because a lot of insulin comes in a vial,” says David Klonoff, MD, of the Diabetes Research Institute at Mills-Peninsula Health Services in San Mateo, CA.
Cons: Multiple steps means a higher chance of making a mistake. McGill says that’s especially true if you’re very young or elderly and have trouble with your hands or with your eyes. “Some may have difficulty seeing the syringe to draw insulin up accurately,” McGill says.
Treating yourself without anyone noticing also isn’t easy.“You have to put a needle in a vial, draw it up, look at it, see that you got the right amount, get the bubbles out, inject yourself -- and you may not always have a private place to do that,” McGill says.
How it works: “The pen is a little device that looks like a pen you'd write with, but instead of ink, it contains insulin,” Klonoff says. You attach a disposable needle on the pen, dial your dose, insert the needle into your skin, give it a click, and you’re done.
Pros: You don’t have to do much to get a pen ready before you use it, which reduces the anxiety you might feel about treating yourself, McGill says. Plus, the needles are tiny -- as small as 4 millimeters long, and thinner than ever. “If you don't squint, you can't see them,” McGill says.
It’s also very easy to use.
“All the insulin you need is in the pen,” Klonoff says. It’s also portable. Once the insulin inside is used up, you throw the pen away, or if it’s refillable, insert a new insulin cartridge.
Some pens even come with a memory feature -- they can tell you when and how much your last dose was.
Cons: They’re more expensive than syringes. But they’re often covered by insurance. Check with your provider.
Pens also have to be kept in the refrigerator before their first use. After that, room temperature is fine.
How it works: Pumps are about the size of a deck of cards and attach to a thin tube called a cannula. You insert the cannula into your skin with a needle and then remove the needle. You can carry the pump around in your pocket or hook it to a belt loop. The pump sends small doses of insulin into your bloodstream throughout the day. When you eat, you push a button for an extra boost of insulin.
Pros: When you use them right, pumps give the best results. “The difference between using a pump and giving yourself multiple injections is like driving a car versus driving a Formula 1 racing car,” Klonoff says. You do have to know how to use it correctly, though, he says, or just like driving a powerful car, you could crash.
It also works with any schedule. Don’t have time to stop during the day to wash your hands or get out supplies? The pump has you covered, even when you’re busy.
Cons: The pump is costly, as are the monthly supplies. Most insurance covers pumps, but there’s often a hefty copay. Also, know that once you choose a pump, you’re stuck with it for a while. “Insurance won't approve another one for 4 to 5 years,” McGill says.
You’re also always attached.You can disconnect for a short while, but you shouldn’t go without insulin for more than 1 or 2 hours.
How it works: Inhaled insulin comes in a powder. You put it in a small inhaler the size of a whistle and breathe it in. Cells in your lungs transfer it to your bloodstream. You use it just before you eat. “It’s for meals or snacks or occasionally if you're too high and need to bring your blood sugar down,” Klonoff says.
Pros: It works quickly. “It gets in fast to blunt the rapid rise of glucose, and it goes away fast to avoid the accidental overshoot with low blood sugar 3 to 4 hours later,” Klonoff says. This helps your blood sugar stay steady over time.
It’s also painless. You don’t use needles.
Cons: Inhalers are not as precise when measuring insulin, so they’re not good at giving small doses accurately.
You also need backup.
You still need another device to give you long-acting insulin between meals, Klonoff says. “Inhaled insulin is not intended as a sole insulin, it's part of the insulin treatment, it can't be the only one.”
Injection port: Ports use a cannula like pumps do, but the cannula isn’t attached to anything. You use a syringe to pump insulin through the cannula into your skin when you need it. You replace the port every few days. The benefit? You don’t have to stick yourself with a needle so much.
Jet injectors: These use a fine stream of insulin to get through your skin. Though they don’t involve a needle, they’re still fairly painful and not very common. “They kind of went away with better needle technology, better pens,” McGill says.
Exciting things are on the horizon for diabetes treatment, McGill says, including a “bionic pancreas” being tested now.
Until then, she says, the key to treating diabetes is taking charge of your health.
“Behavior trumps everything,” McGill says. “If the behavior is right but the numbers are off, a device can fix that.”