Ways to Get Insulin
Years ago, the only way to get insulin inside our bodies was to use big glass syringes that needed to be boiled (to sterilize them) after each use. These days we have more choices. You may use syringes, or you could be on a pump, or using any of several different options.
Syringes
You already know a lot about syringes. The majority of people who take insulin use a syringe -- a shot -- to deliver it. Why? Syringes work well, and are fast, easy, and cheap to use. Plus, they're easy to find in any drugstore in the United States or in other countries.
Pumps
Insulin pumps are little computerized insulin deliverers. You insert a short needle under the skin. The needle is connected to some tubing, which leads to the pump. This is called the infusion set.The pump is usually clipped to your waistband, like a beeper. You fill the pump with insulin (usually enough for two or three days). Then it drips a steady flow of insulin through the tubing, into the needle, and into your body. This steady flow is called your basal insulin dose. Before meals, you hit a button to tell the pump to delivery your mealtime dose. This is called your bolus. ( Think of it this way-bolus rhymes with "bonus" and a bolus dose is kind of a bonus dose you need to take to help your body turn your meal into energy.)
People who use pumps (some call themselves "pumpers") must change their infusion sets and use a new insertion site every few days. Pumpers can adjust their insulin dose easily by programming the pump. This helps them fit their insulin dose to what they do and eat each day. Pumpers have to check their blood glucose a lot. In fact, most pumpers check their blood glucose more often than they did when they used syringes.
What are the pros and cons of pumping? Well, most pumpers love the freedom they get from wearing a pump. Some say it's the closest you can get to not having diabetes. Some say that while you're wearing a pump you can almost forget that you have diabetes for a little while and let the pump take over.
On the minus side, pumps are very expensive (though your parents' health insurance might pay for some of it) and it takes some time and practice to learn how to use it correctly. Usually, your doctor will want you to be in really tight control before even considering putting you on the pump. And, you do have to find a place to carry your pump all the time: on your waistband, in a pocket, or pinned inside your clothes somewhere. But many people say its worth it.
Pens
Insulin pens look a lot like regular pens. Under their cap is a small needle instead of a ballpoint. Insulin pens are already filled with insulin. You just turn a dial to measure your dose. They're easier to take with you than bottles of insulin and syringes. Some people use syringes when they're home and pens when they're out. Pens do have one limitation, though. If you take a mix of insulins, you may not be able to find a pen that has that particular mixture.
Automatic Injectors
Some people have trouble actually pushing the syringe into their skin. If that sounds like you, try an automatic injector. Automatic injectors shoot the needle into you at the touch of a button. Some will even release the insulin automatically. Or you can push the plunger in yourself.
Jet Injectors
Right now, the jet injector is the only delivery system that doesn't involve needles. Instead, the insulin is shot out so fast that it goes through your skin like a liquid needle. What are the plusses and minuses? It takes more work to keep jet injectors clean than it does to toss out disposable syringes. Jet injectors can bruise some people. They're fairly expensive. So it's a good idea to talk to your doctor and to someone who's used an injector if you're thinking about getting one.
Changes
One more thing… Before you make any changes in your diabetes care, talk it over with your parents and your diabetes care team. Different people like different insulin delivery systems. You, your parents, and your team should decide together which is best for you.
Alternative Insulin Delivery Systems
Ever since insulin was first identified as the key to restoring normal glucose levels in people with diabetes, doctors and patients have been hoping for an alternative to insulin injections. Don't get us wrong; injecting insulin works pretty well. Many people have been able to lead relatively normal lives because of it. We have pretty advanced syringe and needle technology, and insulin pens and pumps have made getting insulin into the body even easier. Even so, the quest continues to find an alternative way of administering insulin.
Scientists have been working on a number of new advances in insulin administration.
Transdermal (through the skin)
Our skin is a remarkable organ. It's very good at letting almost nothing in, and letting just a few selected things out. Patches to help people quit smoking have made it seem almost easy to deliver a drug through the skin. In fact, nicotine is a small molecule that is readily absorbed into the skin. It only takes a tiny amount to have an effect on the body. Insulin on the other hand, is far too large to get through the skin without a lot of help. Trying to change that is tough.
Scientists have been working on patches using electrical currents, ultrasound waves, and chemicals to help transport insulin through the skin. Although some companies are hoping to develop products that could provide boluses of insulin through the skin for mealtime, any success for transdermal delivery is likely to come with basal delivery of relatively small amounts over time. Either way, we have a while to wait before insulin patches might be available in pharmacies.
Inhaled Insulin
You've probably been hearing a lot lately about inhaled insulin. Several products are being created in laboratories and have shown success at controlling blood glucose levels. Some of these are products are in the final testing stages, but only one has been approved for use. And, unfortunately, that one is only approved for adults. So you're not going to be using inhaled insulin right away. But research has shown that inhaled insulin works as well as fast-acting injected insulin.
There are a few problems with inhaled insulin, though. First, inhaled insulin does not replace longer-acting insulins, so even if you were taking inhaled insulin you'd still need to inject long-acting.
Second, you have to inhale a lot of insulin to do the same job as a smaller amount of injected insulin. That's because only a small percentage of the inhaled insulin actually reaches the bloodstream and lowers blood glucose. So, a lot of it is "wasted." Because of that, inhaled insulin is pretty expensive-- you have to pay for all that waste. Finally, there are questions about the safety of delivering insulin to the lungs. After all, that's what you're doing when you inhale the insulin. You send it straight to the lungs. Many scientists think the lungs are a great place to deliver a drug because of the large surface area and ready absorption. But that's not what lungs were designed to do. Although inhaling insulin has proven safe in short-term studies, some studies suggest that your lungs might not work as well after years of inhaling insuln.
Exubera's manufacturer, Pfizer, will study the long-term effects of Exubera on the lungs, as well as its safety and effectiveness in patients with lung disease.
Buccal (through the mouth)
Buccal (BUCK-el) insulin is similar to inhaled insulin in some ways. Buccal, or delivery into the mouth, involves a device that delivers a spray of insulin like what you'd get out of a can of spray paint. Instead of going into the lungs, the insulin is absorbed in the lining at the back of the mouth and throat. The good part is that it avoids any problems from putting large amounts of insulin in the lungs. The problem is that even more of the insulin gets wasted.
Other than that, research shows that buccal insulin works about as well as inhaled insulin. One company plans to begin trials in people soon.
Oral
Okay, we've got shots, pumps, inhaled insulin, and insulin sprays. What's left? Pills. You probably already know that insulin taken as a pill is quickly broken down in the stomach, just like the food you eat. That makes it useless for lowering blood glucose levels.
So insulin can't be taken by itself in a pill form. Some scientists are trying to "package" insulin using special coatings, or by altering the insulin structure to get it through the stomach. Like inhaled insulin and insulin sprays, it's likely that a lot of the insulin will be wasted before it gets where it's going. It would probably also take a long time to start working after you swallowed the pill. Not much research has been done on insulin pills so far.
What does all this mean? The fact is, injected insulin (by syringe, pump, or pen) is a really effective way to lower blood glucose levels. Even if one of these insulin delivery methods does become available, it's possible people with diabetes (particularly people with type 1) will still be better able to control blood glucose with injections. For a while, anyway. Or, they may be able to use one of the other methods for their basal dose, but would still need injections for mealtimes and other bolus doses.
