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Diabetes Treatments: Options for Insulin Delivery

Diabetes Treatments: Options for Insulin Delivery. Bonnie Pepon, RN, BSN, CDE Certified Diabetes Educator Conemaugh Diabetes Institute. 21 million people in the U.S. have diabetes $132 billion each year Type 1 diabetes – no insulin production

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Diabetes Treatments: Options for Insulin Delivery

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  1. Diabetes Treatments: Options for Insulin Delivery BonniePepon, RN, BSN, CDE Certified Diabetes Educator Conemaugh Diabetes Institute

  2. 21 million people in the U.S. have diabetes • $132 billion each year • Type 1 diabetes – no insulin production • Type 2 diabetes – some insulin production Diabetes

  3. Type 1 Diabetes

  4. Type 1 Diabetes

  5. Insulin Production of Type 2

  6. Healthy Eating

  7. Sulfonylureas • Meglitinides • Biguanides • Alpha Glucosidase Inhibitors • Thiazolidinediones-TZD’s • Incretin Mimetics • DPP IV Inhibitors Classes of Medications

  8. Glucovance (glyburide/metformin) • Metaglip (glipizide/metformin) • Avandamet (avandia/metformin) • Duetact (amaryl/actos) • New Ones: • Fortamet (metformin SR) • Glumetza (metformin SR) • Actoplus (actos/metformin) • Avandryl (avandia/glimepiride) Combination Drugs

  9. Byetta (Exenatide) approved for type 2 • Symlin (Pramlintide) approved for type 1 and type 2 using mealtime insulin IncretinMimetics: Gut Hormones

  10. Januvia (Sitagliptin) • Oral active, selective inhibitor for the DPP-4 enzyme • A1C effect-decreased by 0.65-0.8% • Can be administered with or without food • Not for type 1 diabetes DPP IV Inhibitors

  11. Insulin Injection Sites

  12. Insulin Delivery SystemsAvailable Now

  13. Insulin comes in U–100 in the U.S. • orange cover and black scale • 100 units of insulin per milliliter of fluid in the vial • U–500 available • high insulin resistance using more than 200 units a day • Outside the U.S.: U-40 • red cover and red scale Syringe/Needle/Vial

  14. Most common method of delivery • Syringes (range of sizes) • needle gauge • needle length • syringe capacity • 3/10cc, 1/2cc, 1cc Syringe/Needle/Vial

  15. Syringes available • 1/2 in or 12.7 mm • 5/16 or 8mm • Pen needles available • ½ in • 5/16 in • 3/16 in • Gauges available • 31, 30, 29, 28 Insulin Needles

  16. Syringes • Syringes are most widely available • Can be adjusted to 1 or ½ units • Can use most types of insulin • Require good vision to measure a dose Insulin Devices

  17. Pens • Easy to set the correct dose by a dial • Can be adjusted with ½ units or 1 unit • Can use most types of insulin • Very convenient and accurate for the vision impaired and those on the go Insulin Devices

  18. Pumps • Results in better diabetes control • More flexible eating schedule • Dose adjusted by 1/10 to 1/20 units • Requires higher level of involvement & more advanced diabetes education and skills Insulin Devices

  19. Multiple manufacturers • BD, Monoject, SureComfort, Ulticare Precision Sure Dose, UltiGuard, Medicore, Aimsco • Injection aides • Inject-Ease by BD and Palco, Instaject (can be combined with a lancet device), NeedleAid, NovoPen 3 Penmate Insulin Syringes

  20. Uses an insulin needle • available in different sizes and gauges • units can be counted as dialed by a click • plunger is pushed in and held for several seconds before removing the needle Insulin Pens

  21. Storage in refrigerator until the pen is started • storage life ranges from 7 to 42 days • Pre-filled pens • 28 days: Humalog/Novolog/Novolin R • 14 days: Novolin N • 10 days: Novalin 70/30 Insulin Pens

  22. Insulin Pumps

  23. Delivers rapid acting dry powder insulin • Absorbed through the lungs into the bloodstream • 1mg and 3mg blister packets • Cannot be used for smokers, children, pregnant women or anyone with lung problems Will be taken off the market in January 2008 Inhaled Insulin

  24. Jet Injector

  25. Minimize needle sticks by creating a portal to inject insulin into • A small tube is inserted into the fatty tissue of the injection site • It is taped in place for 2-3 days • Insulin injected into the tube via pen or syringe instead of the skin Insulin Infuser

  26. Oral insulin • Transdermal insulin • Buccal insulin • Artificial pancreas • Implantable insulin pump Insulin Delivery SystemsIn the Future

  27. 45 year old African-American male • Diagnosed with Type 2 DM • Initial glucose 280mg/dl, A1C–9.9% • Started on nutrition and physical activity • 3 months later still having symptoms • PMH –hypertension, obesity, high lipids • Smoker, occasional alcohol, no drug use What therapy should be started? Case Study

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