Durable pens. Insulin pens that use replaceable cartridges of insulin are also available. Most reusable pens are made of metal but otherwise have about the same features as disposable pens and a comparable cost.
Another option that has been available for several years is insulin jet injectors. Jet injectors use a mechanism to produce high-pressure air to deliver a fine spray of insulin through the skin. Once the appropriate dose of insulin has been loaded into the injector, it is placed against the skin and the trigger, or button, is pushed. The high pressure causes the insulin to vaporize and penetrate the skin so that it reaches the subcutaneous tissue. Some bruising may occur from injections using a jet injector, but bruising can be minimized by adjusting the pressure (setting) of the spray. The pressure may have to be adjusted differently for different injection sites.
It is extremely important to follow the manufacturer’s guidelines on the care and cleaning of the device to maintain sterility. Jet injectors are generally not recommended for people who take blood thinners, are undergoing dialysis, or have hemophilia.
If you are interested in using a jet injector, work with your diabetes care team to learn the proper technique. In addition, check with your insurer to determine whether the cost of the device is covered.
Inhaled insulin was approved by the Food and Drug Administration in January 2006, but the only inhaled insulin to reach the market so far — Exubera — was discontinued in October 2007. Other drug companies are working to gain approval of their products by the Food and Drug Administration.
External insulin pump
Insulin pumps are becoming more popular as the technology improves and additional features are added. Some pumps are now available that work in conjunction with continuous glucose monitors that can alert the user to high or low blood glucose levels if programmed to do so.
Insulin pumps have traditionally been used primarily by people with Type 1 diabetes, but they are becoming a treatment of choice for many with Type 2 diabetes, as well. Most insulin pumps are small devices about the size of a cell phone. (The exception is the OmniPod, which is even smaller and is attached directly to the skin, with no tubing necessary.) The pump itself can be clipped onto the waistband of your pants or skirt or placed in a pocket. A length of plastic tubing connects the insulin reservoir within the pump to the infusion set, which is taped onto the skin and contains a small catheter (often called a cannula), through which insulin enters the body. The catheter is commonly inserted into the abdomen or buttocks and needs to be changed every 48 hours.
The pump user programs the insulin pump to deliver insulin at a slow, continuous (basal) rate as well as in supplemental (bolus) doses before meals and to correct for high blood glucose. Basal and bolus dosing most closely resembles how the pancreas releases insulin in a person without diabetes.
Using an insulin pump requires commitment and frequent blood glucose monitoring. According to the American Diabetes Association, people who demonstrate the following characteristics are more likely to do well with pump therapy:
• Strongly motivated to improve glucose control
• Willing to work with their diabetes care team
• Willing to assume substantial responsibility for their day-to-day care
• Able to understand and demonstrate use of the insulin pump
• Willing and able to frequently perform self-monitoring of blood glucose
• Knowledgeable about using their blood glucose monitoring data to make dose adjustments