Currently, 8.3% of the US adult population, or 25.8 million people, have diabetes. Of these cases, more than 90% are cases of type 2 diabetes (T2DM), and it is estimated that at least 1 million cases are type 1 diabetes (T1DM). Although various oral drugs can be used in patients with diabetes, insulin is still an important part of treatment
Insulin is the standard treatment for patients with T1DM, and is ultimately used in patients with T2DM. It does not respond adequately to other treatments. Although in some cases, insulin can be administered intravenously (for example, using an insulin pump), the vast majority of insulin is administered subcutaneously.
Available forms and management
In the United States, there are 2 types of insulin available: recombinant human insulin and insulin analogs. Recombinant human insulin is available from 2 manufacturers (Humulin by Eli Lilly and Novolin by Novo Nordisk); each of them can be obtained in regular and long-acting neutral protamine incubation (NPH) form. Unlike recombinant human insulin, insulin analogs are structurally modified forms of insulin, which are designed to rapidly lower blood glucose or maintain low blood glucose levels over time. These insulin analogs can be divided into fast acting and long acting insulin. Rapid insulin includes insulin lispro, insulin aspart and oryzanol, and long-acting insulin includes insulin glargine and insulin detemanin. Pre-mixed insulin formula is also available
Regardless of the differences between insulin preparations, all conventional types of insulin can be administered subcutaneously. Subcutaneous injection can be given in one of two ways: 1, 2,
Disposable plastic syringes: syringes are available in sizes of 1, 0.5 and 0.3 mL. Because most diabetic patients use less than 30 units of insulin per injection, the smallest syringe size is most commonly used. Carefully remove the drug from the insulin vial and inject it into the syringe. The tiny gradient mark in the syringe helps to measure the insulin dose. Typically, insulin vials contain 10 mL of insulin at a concentration of 100 units/mL.
Insulin pens: Pens can be pre-filled and disposable, or refillable (using an insulin cartridge), although most pens are disposable. In both cases, each pen contains 3 mL of insulin. Before giving a subcutaneous injection, connect a very short, very thin needle to the pen.
Insulin pen VS insulin bottle
Insulin pens have several advantages for diabetics. First, the insulin pen eliminates the need to carry and transport vials and syringes, and improves convenience and compliance. In addition, patients with T2DM, especially advanced T2DM, may have vision problems or dexterity problems, and insulin measurement using plastic syringes is very difficult. The author's benefits in improving the acceptability of insulin therapy and compliance with insulin therapy have been proven in clinical studies: 1,2:
In a 6-month observational study of 74 patients with T1DM and T2DM, investigators interviewed patients using vial/syringe management systems and patients using insulin pens. Most (95.2%) pens using insulin pens were easy to use, while fewer than half (46.7%) of patients used conventional vial/syringe techniques, the difference was statistically significant (P <0.001). Patients using pens were twice as likely to read dose scales as patients using conventional vial/syringe technology (61.9%, 26.7%; P = 0.037).3
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