Choosing the Right Insulin Delivery Methods: UK Options and Considerations (2023)

Effective insulin delivery is crucial for managing diabetes.

With various options available in the UK, choosing the right insulin delivery method for your needs is important. Your doctor usually decides which methods are best for you and gives you several options.

In this article, we’ll cover everything you need to know about the different insulin delivery devices so you can make an informed decision.

As one of the most vital hormones for human survival, pharmaceutical companies are constantly developing new ways to deliver and administer insulin. Your healthcare provider chooses the best insulin delivery systems based on your diabetes management plan.

Here are some of the insulin delivery devices they might recommend.

Traditional insulin syringes are the most common insulin delivery method worldwide. It involves a small glass vial of insulin and a syringe with a plunger and a needle.

Insulin syringes deliver insulin into the subcutaneous layer of the skin, and you need to rotate the injection site every time to avoid irritation or injection site reactions.

These syringes come in various sizes and gauges depending on your insulin dose and the type of insulin you take. Your healthcare provider can help you determine the best syringe gauge and needle length.

• Cost-effective: The most affordable insulin delivery device.

• Simple: Don't require much training.

• Availability: Readily available at clinics and hospitals.

• Self-administration: People with muscle or nerve problems can have a hard time pulling the plunger to withdraw insulin from the vial.

• Needle Phobia: Not great for people with needle phobia who have to take multiple injections daily, such as those with type 1 diabetes.

• Needlestick Injury Risk: Syringes have a high risk of needlestick injuries in healthcare settings and even at home, making waste disposal a hassle

An insulin pump is a small programmable medical device that delivers insulin doses directly into your body using a catheter inserted under the skin.

Insulin pumps help you manage your blood sugar levels more effectively and conveniently than traditional insulin injections.

These pumps can be programmed to administer insulin at mealtimes called bolus insulin to keep your blood glucose levels from spiking after meals. It's equivalent to the shot of short-acting insulin you'd normally take a few minutes before eating.

Unlike traditional syringes, you'll still need to tell your insulin pump to give you a bolus dose, but you won't need to prepare it.

Pumps can also be programmed to deliver a continuous subcutaneous insulin infusion called basal insulin. This long-acting insulin dose keeps your blood sugar steady throughout the day and when you sleep at night.

With these two methods of insulin administration, insulin pumps mimic the body's natural insulin patterns. It saves you the trouble of taking multiple daily injections. However, you still need to program the insulin pump and tell it how much insulin to administer each time.

There are generally two types of insulin pumps: external and implantable.

External insulin pumps, the most common type, are usually made up of three parts:

• The Pump: Contains the insulin reservoir and usually has a small computer screen, about the size of a smartphone, for programming your insulin doses.

• Tubing: A small, thin tube that connects the insulin reservoir to the infusion set.

• An Infusion Set: Contains a fine cannula that goes under the skin in the subcutaneous layer to deliver insulin.

External insulin pumps can be attached to your belt, kept in your pocket, or strapped to your arm or stomach beneath your clothes.

Some external insulin pumps, called patch pumps, lack the tubing but instead use a patch-like device that sticks directly to the skin.

Implantable insulin pumps, on the other hand, are well hidden because they are surgically implanted beneath the skin. However, this type of insulin pump is still under development, and very few people have tried it.

• Improved Glycemic Control: Delivers insulin in a consistent and controlled manner that minimizes blood sugar fluctuations.

• Fewer Injections: Eliminates the need for frequent, painful insulin injections.

• Flexibility: Work with different insulin preparations, such as long- and rapid-acting insulin.

• Expensive: Typically more expensive than syringes and pens.

• Maintenance: Requires regular maintenance such as changing the catheter, refilling the insulin reservoir, and programming the device.

• Dose Programming: Incorrectly programming the insulin pump can lead to inaccurate insulin doses, which causes low or high blood sugars.

• Lifestyle Restrictions: You might be unable to do certain activities while wearing insulin pumps, such as swimming or exercising in extreme temperatures.

An artificial pancreas, also called a closed-loop system, is an insulin delivery device composed of three parts:

• Insulin pump

• Continuous glucose monitor (CGM)

• Control algorithm

A CGM is a small sensor that goes under the skin and measures your blood glucose levels throughout the day. Continuous glucose monitors then relay these readings to your smartphone or any device you prefer via a wireless Bluetooth transmitter.

Unlike a traditional glucometer, CGMs give you real-time glucose data that can drive your food choices and insulin doses.

A continuous glucose monitor connected to an insulin pump reads your blood sugar levels and tells the pump to release insulin accordingly. Together, they act as an artificial pancreas that reads fluctuations in your blood sugar and releases the right amount of insulin.

The control algorithm helps the insulin pump determine the correct amount without input.

This closed-loop system is usually recommended for people with type 1 diabetes and those with difficulty controlling their blood sugar.

• Accuracy: Insulin doses are based on real-time CGMs feedback, improving accuracy.

• Convenience: You don’t need to program the device or take multiple injections daily.

• Remote Monitoring: CGMs can send alerts to family members or healthcare professionals in emergencies such as severely high or low blood sugar levels.

• Expensive: Artificial pancreas is even more costly than typical insulin pumps.

• Complexity: It requires extensive training and education to use and adjust it properly.

• Limited Availability: While closed-loop systems are becoming increasingly popular, they are still not widely available in some countries.

Insulin pens are a great alternative to traditional syringes. They provide accurate, standardized doses since you don’t need to draw up insulin from a vial.

Insulin pens are also easier to carry, less likely to break than an insulin vial, and much more discreet than syringes.

There are generally two types of insulin pens:

• Disposable insulin pen: Comes pre-filled with insulin and is thrown away once you finish all the insulin doses.

• Replaceable cartridge pen: This can be used more than once by replacing the insulin cartridge.

Insulin pens have fine pen needles that need to be switched with every use, but they are much smaller and more convenient than traditional hypodermic needles.

Your healthcare provider can help you decide between different pen needle gauges.

• Easy to use: You don’t need to program it or draw insulin from a vial. You just set the dose and inject.

• Dose Accuracy: The preset doses allow uniform insulin dosing each time.

• Portable: You can easily carry them in your pocket or bag.

• Limited Dosing: Most insulin pens offer limited dosing options, so you can only take the dosing increments specified on the pen.

• Compatibility: Some insulin pens are only compatible with specific cartridges.

Insulin injection aids are special devices that make insulin syringes easier to use. They’re especially useful for older people with difficulty seeing, handling, or using a traditional syringe and needle.

Examples of insulin injection aids include the following:

• Syringe Magnifier: This aid is designed to help people with poor vision by enlarging the markings and readings on the insulin syringe so they can read the dose. Magnifiers also make it easier to hold a syringe.

• Syringe-filling Device: This aid helps you load the syringe with minimal effort by simply touching a button on the device.

• Easier Administration: Syringe-filling devices can automatically fill the syringe with the correct dose of insulin.

• Improved Accuracy: These aids can help people with vision problems or tremors accurately measure and draw up their insulin doses.

• Additional Cost: Insulin injection aids add to the overall cost of your diabetes care.

• Limited Compatibility: Not all insulin syringes are compatible with these aids.

Insulin jet injectors, also called needle-free injection devices, deliver insulin directly into the skin without using a hypodermic needle, hence the name.

These Insujet devices consist of a small, handheld injector that contains an insulin reservoir, a spring-loaded mechanism, and a disposable needle or nozzle.

When you press the button, the spring-loaded mechanism activates, pushing the insulin out of the needle or nozzle and into your skin.

Needle-free injectors rely on high pressure to guide the insulin into your subcutaneous layer through the pores of your skin. All of this happens in seconds.

Despite the high pressure that turns the insulin dose into a fine jet stream, jet injectors are virtually painless. For example, InsuJet produces a fine steam with a 150 μm diameter. That’s thinner than 2 sheets of regular paper and several times smaller than a needle.

• Virtually Painless: The high-pressure stream of insulin delivers the medication quickly and precisely, reducing the discomfort and pain associated with traditional injections.

• Needle Phobia: As a needle-free injection device, jet injectors are perfect for people with needle phobia.

• Accuracy: Insulin jet injectors are designed to deliver precise doses of insulin, helping you maintain better control over your blood sugar levels.

• Reusable: Most jet injectors are reusable. For example, InsuJet can be used for up to 5,000 injections, which saves you the trouble and cost of waste disposal.

• Cost-effective: Jet injectors save you money in the long term, especially if you take multiple injections daily, such as in the case of type 1 diabetics.

• Skin Reactions: As with all insulin injections, you might develop a skin reaction such as redness, tenderness, or a rash if you don’t rotate the injection site regularly.

• Insurance Coverage: Some insurance plans don’t cover insulin jet injectors

Insulin inhalers use compressed air to deliver your insulin dose to the bloodstream through the lungs. The inhaled insulin can be either dissolved rapid-acting insulin or dry, micronized insulin powder.

Inhaled insulin is still being researched, and only rapid-acting insulin is currently available in inhaled form. This means diabetics still need to take long-acting insulin injections using an insulin inhaler.

This insulin delivery method isn’t very popular among diabetics and people with comorbidities such as asthma or lung diseases.

• Fewer Injections: While you still need to take long-acting insulin injections, inhalers save you the trouble of taking injections with every meal.

• Portability: Insulin inhalers can be taken anywhere and don’t need refrigeration or special storage settings.

• Lung Problems: Insulin inhalers aren’t suitable for people with lung problems or even if you catch a cold.

• Requires Technique: They require proper technique to make sure the insulin reaches your lungs, which can be challenging for some people, especially children or older adults.

Being a protein-based hormone, insulin can’t normally be taken orally because, like all proteins, stomach acids would just digest it.

However, several attempts have recently been to create an acid-resistant oral insulin such as pills or tablets. While the research shows this is possible, it would be extremely complicated and expensive.

Even if the insulin were to overcome the stomach acids, it would still have a hard time passing through the stomach wall for absorption because of the wall thickness.

Many companies have developed oral insulin pills and are currently testing them on animals to find a way to bypass the stomach absorption problem.

In the meantime, scientists are working on a buccal form of insulin that can be absorbed through the inner walls of the cheeks.

• Ease of Use: Pills are easier to use than insulin injections.

• More Compliance: Patients are more likely to follow their doses with pills than with injections, especially those with needle phobia.

• Variable Absorption: It can be difficult to predict how the insulin will be absorbed, especially with food and drink.

• Gastrointestinal Side Effects: Oral insulin can cause gastrointestinal side effects, such as nausea, vomiting, and diarrhea.

New insulin delivery devices are being created almost every year to help you take your insulin easily and comfortably.

However, no matter which device you choose, following your dosing schedule to keep your blood sugar in check is important.