diabetes drug devices

what is type 1 diabetes

 ~ 5-10% of patients with DM

 Autoimmune destruction of the β cells in the pancreas → no insulin production

 Diagnosed at any age (most commonly < 20 years of age)

 Rapid onset of symptoms

 Usually thin or lean

 Medication Use: Basal and Bolus Insulin Products

what is type 2 diabetes

 ~ 90-95% of patients with DM

 Non-autoimmune, progressive loss of β-cell insulin secretion, often on a background of insulin resistance.

 Diagnosed at any age (most commonly > 30 years of age)

 Insidious (gradual) onset

 Usually obese or history of obesity

 Medication Use: Non-Insulin and Insulin Products

what is basal insulin

Covers needs between meals and overnight. NPH, glargine, degludec, icodec, efsitora

what is bolus insulin

Covers carbohydrates and brings high glucose down. Rapid- acting analogs or regular insulin

Lispro (Humalog, Admelog), Aspart (Novolog, Merilog, Kirsty), Aspart + Niacinamide (Fiasp), Glulisine (Apidra) are examples of what insulin

rapid acting bolus

Regular (Humulin R, Novolin R) and Comes in U-100 and U-500 are what kind of insuin

short acting bolus

what type of insulin is cloudy

NPH (Humulin N, Novolin N)

NPH (Humulin N, Novolin N) is an example of what insulin

intermediate acting basal

Glargine (Lantus, Toujeo, Basaglar, Semglee, Rezvoglar) is what type of insulin

long acting basal

Degludec (Tresiba) is what type of insulin

ultra long acting basal

advantages and disadvantages to insulin vial + syringe

Advantages

•Lowest cost

•Allows for self-mixing of some insulin types

Disadvantages

•Higher risk of dosing error

•Challenging for patients with visual impairment and/or dexterity issues

advantages and disadvantages to insulin pen

Advantages

•Portable and compact

•Discreet

•Precise dosing

•Fewer manipulations for administration

Disadvantages

•More expensive than vial and syringes

•Unable to self-mix insulin types

advantages and disadvantages to insulin pump

Advantages

•Precision in insulin dosing (e.g., basal rates, dosing in decimals)

•Flexibility in lifestyle

•Reduces burden of multiple insulin injections

Disadvantages

•Most expensive option

•Requires advanced patient education for

appropriate use

•Site infection; DKA within hours if delivery

stops

what types of insulin types can be mixed

nph with short acting and rapid acting

how often are trulicity, ozempic, and mounjaro dosed

weekly

how often is victoza dozed

daily

what are incretin injectables

 Indications: To improve glucose control for patients with type 2 diabetes.

 Trulicity, Ozempic & Mounjaro: reduce the risk of major cardiovascular (CV) events

 Ozempic: reduce the risk of worsening kidney disease and kidney failure

 Non-insulin products

 Glucagon-like peptide 1 (GLP-1) receptor agonists (RA)

Single-Dose Autoinjector: Trulicity®, Mounjaro

 Needle is built in and hidden: no needle to attach, no priming, no dose to dial

 Uncap, place flat on the skin, unlock, then press and hold

 Hold until the second click (up to 10 seconds)

 The whole pen goes into the sharps container

 Once weekly, on the same day each week

Multi-Dose Prefilled Pen: Ozempic®, Victoza®/liraglutide

 Attach a new pen needle for every injection

 Flow check only with each new pen

 Dial the dose; the dose counter shows the dose selected

 Hold 6 seconds after the counter returns to 0

 Ozempic weekly; Victoza daily. Remove the needle after each injection

how to minimize subcutaneous injection pain

Injecting product at room temperature

Allow alcohol to dry completely before injection

Relaxing muscles at the injection site

Inserting needle quickly

Avoid changing direction of the needle during insertion or withdrawal

Continuous Subcutaneous Insulin Infusion (CSII)

 An insulin pump:

 Small, electronic device that delivers rapid-acting insulin at a set interval

 Mimics the pancreas by insulin delivery on a basal (continuous) and bolus (mealtime) schedule

 Advantages:

 Flexible dosing

 Fewer injections

 Improves lifestyle flexibility

 Requires:

 Highly motivated patient

 Regular glucose monitoring

 Device management

 Supplies required

 Pump

 Tubing (for tubed devices)

 Infusion set

 Cannula

 Bolus insulin

 Insulin reservoir (sizes vary)

 Integration possible with continuous glucose

monitors (CGMs)