Insulin plays an important role in keeping blood glucose at safe levels. Receiving the right amounts of insulin at the right time is necessary for achieving the best possible blood glucose outcomes and preventing both short- and long-term complications. For those with type 1 diabetes, little to no insulin is produced by the body. Those with type 2 diabetes still produce some insulin on their own, but not enough to properly regulate blood glucose levels. All people with type 1 diabetes, and many people with type 2 diabetes, must take insulin to manage their diabetes.
Insulin is usually administered into the fatty layer just under the skin in one of the following locations:
Insulin Delivery Methods
There are a variety of methods in which a person with diabetes can take insulin, including:
- Insulin Pen
- Insulin Pump
Do know, one method is not necessarily better than another. Each person with diabetes has individual needs and should choose the option that is best for them!
Insulin syringes have been used since 1924 and were originally big, heavy and reusable. With improvements over time, they are now much smaller and disposable. They come in a variety of sizes holding 30, 50, or 100 units of insulin. The needles are extremely thin with common lengths ranging from 3/16” (5 mm) to 1/2” (13 mm). Line markings allow for dosing in ½, 1- or 2-unit increments.
Insulin pens are a popular alternative to syringes. There are two types, disposable and reusable. Disposable pens are pre-filled with insulin and can be recycled once the cartridge is near empty (or the pen has been in use for the number of days allowed by the manufacturer) . Reusable pens utilize replaceable cartridges of insulin. All pens require disposable needles to deliver the insulin. Pen needles come as short as 4mm in length and are even thinner than syringe needles! Users simply dial to select the insulin dose, insert the needle into the skin, and press a button to deliver the desired dose. Pens deliver insulin accurately to the nearest ½ or 1 unit, and are especially convenient for those with active lifestyles as well as those who have challenges with vision or dexterity.
It is worth noting that for those with severe needle phobias/anxieties, use of insulin syringes and pens can be made much easier through use of an INJECTION PORT – a device that sits on the skin surface and connects to a flexible tube (cannula) that sits below the skin. Injections can be made into the port rather than into the skin directly. The port is typically changed every 3 days.
An insulin pump is a small, battery powered device. It is worn outside of the body and attaches anywhere you’d normally give an insulin injection. It allows for more precise and flexible insulin dosing than a syringe or pen. Pumps can be a good option for anyone on multiple daily injection therapy.
A pump uses only fast acting insulin delivered through a small tube (cannula) that is placed just under the skin. You fill the pump reservoir with insulin and change your set every 2-3 days. Initially a pump is programmed based on your current dosing. Your health care team determines these initial settings. They will need to be confirmed & modified after starting pump therapy and periodically afterwards.
Blood glucose levels must be monitored frequently when you initially start on your pump.
Using your pump’s calculator feature helps you determine your recommended dose for food and corrections while keeping track of unused insulin.
With this type of pump, insulin flows through tubing to the cannula. The tubing varies in length from 23-43 inches. Insulin is delivered by using buttons (or a touch screen) on the pump itself, or via a smartphone application.
There are also tubeless pumps that stick directly to the skin and insert their own cannula just below the skin. These pumps require a separate controller to administer insulin and make changes to delivery settings.
Both of these pump types are programmed to give a steady stream of insulin 24 hours a day, known as “basal” insulin. They provide fine-tuning of both basal and mealtime insulin and alleviate the stress of multiple daily injections. Some pumps also work in conjunction with a continuous glucose monitor (CGM). These hybrid-closed loop systems use real-time glucose trends from the CGM to make adjustments and recommendations for keeping glucose levels as close to normal as possible.
These mechanical pumps stick directly to the skin’s surface. They can deliver a single, flat rate of insulin through the day and night. They also deliver boluses of mealtime insulin in fixed increments by pressing or squeezing buttons on the device.
Rapid-acting insulin can be taken through an inhaler. This insulin comes in a dry powder form contained in a small cartridge that is placed into a reusable inhaler. When inhaled, the insulin is delivered directly to the lungs where it is quickly absorbed into the bloodstream. Inhaled insulin has a faster onset, earlier peak and shorter duration of action compared to injected or pumped insulin.
What is best for you?
When selecting the best method of taking insulin, look at the big picture. Reach out to your professional diabetes-care team so they can help you “pump shop.” Consider cost, insurance coverage, lifestyle, and personal preferences. Insulin management is crucial. It must be done in a way that meets your personal needs, allowing you to manage your diabetes as effectively as possible. Be sure the method or product you choose is best for YOU.
©Gary Scheiner MS, CDCES – Integrated Diabetes Services. May be reproduced and used for patient education, but not sold.