Aspects of Insulin Treatment
- Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the Division of Endocrinology, Mount Sinai School of Medicine, New York, New York.
This is the second of a series of articles based on presentations at the American Diabetes Association Scientific Sessions held 5–9 June 2009 in New Orleans, Louisiana, pertaining to insulin treatment approaches. At a symposium on aspects of continuous subcutaneous insulin infusion (CSII) treatment, Nancy Bohanon (San Francisco, CA) discussed new approaches to make this treatment available for subjects with type 2 diabetes and pointed out that “the pumps work!” She predicted that several of these products might be available within the next year.
Patch pumps
The Valeritas h-Patch technology has been used to develop a V-Go insulin patch pump (www.valeritas.com) to deliver both basal and bolus insulin, requiring a fixed basal dose, which appears to be preset to rates of 20, 30, and 40 units per 24 h. For bolus delivery, each click delivers 2 units up to a total of 36 units per 24 h. The pump is worn for 24 h, filled with an external device, with the backing removed to adhere to the skin. A button on the pump is pressed to insert a 30G needle. Bolus doses are delivered by pressing a button on one side that releases a bolus delivery deployment button—a safety feature to prevent accidental bolus delivery. After 24 h, a button is pressed to withdraw the needle. The device is purely mechanical, does not require a battery-driven pump or external controller, fits under clothing, and can be operated through clothing. In a user-preference program, patients liked it and considered it to be easy to use, discrete, and comfortable, although the filling mechanism was not considered to be ideal. Common to a number of these devices, although presumably allowing a less complex delivery mechanism, the single preset basal rate is somewhat disadvantageous, as an important benefit of CSII basal rates is the ability to …
