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Endocrine Clinical Pharmacy Specialist
CGM and Remote Monitoring Program Coordinator
Endocrinology and Metabolism Institute
Diana Isaacs, PharmD, BCPS, BCACP, CDCES, BC-ADM, FADCES, FCCP, has disclosed that she has received consulting fees from Abbott, Dexcom, Insulet, Lilly, Medtronic, and Novo Nordisk.
More than 10% of the US population is currently living with diabetes. Every person with type 1 diabetes requires insulin to live, and many people with type 2 diabetes require insulin at some point in their lives. Fortunately, these individuals now have several choices on how they can receive their insulin. Although insulin pumps are becoming more common, especially among people with type 1 diabetes, most individuals requiring insulin are still using insulin pens, which are generally preferred over vials and syringes due to their ease of use and accuracy with dosing. Connected insulin pens take these features a step further and incorporate a dosing calculator, reminders/alerts, and connected data through the use of a mobile application.
The Dosing Calculator
Many people with diabetes struggle with knowing how much insulin to take, especially at mealtimes. The dosing calculators included within connected insulin pens typically have 3 options to assist with this challenge: carbohydrate counting, set doses, or meal estimates. Carbohydrate counting requires people to add up the number of carbohydrates in their meal and the pen delivers insulin based on this answer. Set doses give a set amount of insulin for each meal or snack. Finally, meal estimates give more or less insulin for a small, medium, or large meal. In addition, the current glucose reading is used to add or subtract insulin. For example, if a person’s glucose target is 120 mg/dL but the current glucose is 160 mg/dL, more insulin would be added to the mealtime dose. However, if the person’s current glucose is 80 mg/dL, less insulin would be given. The exact amount of insulin is determined based on programmed settings, which can be calculated and adjusted by the healthcare team.
Connected insulin pens can be configured to include helpful reminders and alerts. For example, an alert signals when insulin is more than 28 days old, the expiration time for most mealtime insulins. In addition, an alert will signal if the temperature exceeds the recommended threshold, because this can compromise how well the insulin works. Several optional alerts can also be set to remind people to take their insulin at specific times of the day or to check their glucose level.
Connected insulin pens can be linked up with Bluetooth glucose meters or continuous glucose monitors. When this is done, the data appear in a mobile application and on a report that can be shared with the healthcare team. Because the person with diabetes can choose to take more or less than the recommended doses of insulin, this ability to view the data is extremely helpful for healthcare professionals as it allows them to see how much insulin was actually administered. Without these data, as is the case for most people on traditional insulin pens, it is very challenging for the healthcare team to know how to adjust the insulin regimen to achieve the optimal glucose targets. Connected insulin pens remove this barrier and allow for easy data interpretation and more accurate insulin adjustments. Although this technology is also available with insulin pumps, it has just recently become available for insulin pens.
The Best Feature of All
In my opinion, the best feature of connected insulin pens is the ability to correct high glucose levels without the worry of insulin stacking. Insulin stacking is when a person gives additional correction insulin doses to lower a high glucose level. This can be dangerous, however, because rapid-acting insulins are generally at work in the body for 4-5 hours. Taking additional insulin doses during this time, therefore, can cause there to be too much insulin in the body, which leads to hypoglycemia. To avoid this problem, people using a connected pen can enter in their current glucose level, and the mobile app will subtract how much active insulin is working in the body to recommend the optimal dose of insulin to lower their glucose level, while reducing the risk of hypoglycemia.
Despite the potential to greatly improve type 1 and type 2 diabetes management, connected insulin pens are unfortunately underused. This will likely change as more and more options become available that can be obtained from a pharmacy with a prescription.
Which feature of connected insulin pens are you most excited about? Answer the polling question and join the conversation by posting a comment.