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Before the discovery of insulin in 1921, diabetes was a disease that most people feared; death was certain, and sufferers died slowly…becoming weaker and weaker, until their bodies simply could not continue to stay alive. Ironically, sometimes the strict diet necessary to minimize their sugar intake caused diabetics to starve to death.
There is still no cure for diabetes, but insulin – along with various lifestyle adaptations – enables patients to live a relatively normal life. For people with diabetes, a primary concern each day is getting enough insulin. The predominant means of insulin delivery today are syringes, pens, automatic injectors, jet injectors, and pumps.
Ensuring that diabetics have viable choices in how to administer their daily insulin has kept scientists busy for decades. Alternatives currently in the research, development, and/or trial stages include transdermal, inhaled, buccal, oral, and liver.
Insulin via Syringe
The traditional way of administering insulin is via a syringe. Readily available in most parts of the world, syringes are still preferred by the majority of insulin-users. They’re fast, simple, and cheap to use. The user draws insulin from a bottle, measures the desired amount, and injects themselves. A disadvantage of the syringe method is that it is always necessary to carry around both a bottle and a syringe.
An insulin pen looks much like an ordinary pen. This method involves using a pre-filled insulin cartridge. The user must attach the needle, dial the dose, and inject the insulin. A convenient way to take insulin anytime, using a pen makes insulin use easy to deal with away from home; there are no bottles and syringes to pack around. Pens tend to be more expensive than syringes, and if you use a mix of different insulin types, it may be difficult to find a pen with your specific mixture.
Insulin by Automatic Injector
This method shoots the insulin into the user by pressing a button. Some automatic injectors release the insulin automatically while others require pushing the plunger. This method is a good option for people who’re uncomfortable pushing the syringe into their skin.
Insulin via Jet Injector
Currently, this insulin-delivery method is the only one that doesn’t use needles. The insulin is shot with such speed that it penetrates the skin like a liquid needle. The downside is that jet injectors require work to keep jet injectors clean (vs. the ease of a disposable syringe), they bruise some people, and they’re expensive.
Insulin by Pump
The size of a cell phone, the insulin pump is a computerized delivery method. At one end of the pump the catheter is inserted via a small needle into the user’s abdominal fat, and taped into place. The catheter tubing leads to the pump; the pump’s reservoir is filled with enough insulin for two or three days. In the same way that a syringe has a plunger to push the insulin out of it, the reservoir has a plunger that’s pushed by a small device.
Dosage instructions must be programmed into the pump’s computer; the insulin will then drip a steady flow into the wearer’s body. Everything that’s crucial to controlling diabetes via insulin syringe is doubly vital when using a pump; blood glucose levels must be checked more frequently than with a syringe-delivery system, and the wearer must know how to make adjustments in food, insulin, and physical activity in response to glucose test results.
Some people enjoy the freedom and more flexible lifestyle offered by wearing an insulin pump. The pump negates the need to eat a certain amount of food at a specific time. Pumps use short-acting insulin, so the hormone isn’t administered until needed, which can result in fewer insulin reactions.
Pumps, however, are very expensive, and it takes a certain amount of dexterity, time, and practice to learn to use them correctly. While the wearer can disconnect the tube for showering or other short-term activities, the pump is worn twenty-four hours a day, every day – on your waistband, in a pant or shirt pocket, pinned inside clothing, or on a belt. And because only short-acting insulin is used, a disruption in the flow of insulin can lead to a dangerous rise in blood sugar level.
The Future of Insulin-Delivery: Alternative Methods
Scientists continue to explore alternative insulin-delivery methods. This is especially good news for those who are uncomfortable with needles.
Active transdermal technology enables insulin to be absorbed through the skin using an applied force such as chemicals, ultrasonic waveforms, and low-level electrical currents. This is different from the passive transdermal delivery method used in a skin creams, patches, or sprays. Active transdermal systems deliver large molecular substances through the skin and on into the bloodstream. Several manufacturers offer skin pads that use active transdermal technology to deliver insulin.
This method brings insulin directly into the lungs via a device resembling an asthma inhaler. In studies, those who use inhaled insulin were found to suffer fewer overall bouts of hypoglycemia. However, they tended to experience more severe hypoglycemia more frequently.1
Another downside of this method is the amount of inhaled insulin necessary to get enough. Only a small percentage is able to reach the bloodstream, so much of the hormone is wasted. This is reflected in the high cost of inhaled insulin. Additionally, since the lungs are not designed for this purpose, concerns about the safety of this delivery method abound.
While there are several drawbacks to inhaled insulin, for diabetes type 1 sufferers who are unable to have pre-meal shots, inhaling insulin could be a viable diabetes management regimen.
Buccal Insulin Delivery
Still in the final stages of development, the buccal insulin method uses a device that – similar to a spray paint can – delivers a spray that is absorbed into the lining at the back of the mouth and throat. As with the inhaled method, a high percentage of insulin is wasted. However, this method is not associated with the safety concerns attached to delivery via the lungs.
Oral…An Insulin Pill
While an insulin pill has been under investigation for the last three decades, the problem of speedy breakdown in the stomach caused by digestive juices has not yet been resolved. There have been various attempts to design special coatings, but so far a solution that provides both a digestive shield while enabling absorption has not been discovered.
Delivery directly to the liver is also being explored.
While ongoing research for effective, non-needle insulin delivery methods in the future looks promising, insulin injected by syringe, pen, or pump is still the most effective method of lowering blood glucose levels.