1. Insulin delivery
devices
Dr. Manal Mustafa
Consultant Pediatric
Endocrinologist
Latifa Hospital

2. Objectives
• Introduction
• Types of insulin delivery devices
• Effectiveness of insulin pump in
pediatric type 1 DM
• Criteria to shift patient to pump
• Basics of insulin pump
• Advantages and disadvantages

3. Insulin delivery devices
• These include syringes, insulin pens and insulin pumps.
• No single device or type of device works well for everyone. The
decision of which to use may be based on:
– a person’s insulin regimen
– ability to manipulate or operate a particular device
– visual ability
– insurance coverage or ability to afford a particular device and
related supplies
– occupation, and daily schedule

4. Syringes
• Medical syringes are relatively small,
disposable, and have fine needles with
special coatings that make injecting as
easy and painless as possible.
• Syringes come in a variety of sizes,
with different needle gauges
(thicknesses), and different needle
lengths. The higher the gauge, the
finer (thinner) the needle.

5. Insulin pens
Insulin pens look similar to oversized ink pens, making them a convenient way of carrying
insulin.
Most pens hold 300 units (3 ml) of insulin and deliver doses in one-unit increments, with up to
60 to 80 units per dose.
Some pens are disposable, while others use replaceable cartridges that are inserted into the
pen.

6. • The NovoPen Junior and the HumaPen Luxura HD deliver insulin in
half-unit increments. One of the biggest advantages of insulin pens
is accurate dosing.

7. Pen needles
• Like syringes, pen needles come in a variety of needle gauges and
lengths.
• Pen needles are slightly thinner and shorter than syringe needles,
so injections may be more comfortable.

8. Auto Shield Duo™ pen
needle
• It is a safety pen needle that helps
prevent needle stick exposure and
injury during injection and disposal.
• Has an outer shield that conceals the
5-mm single-use needle, so patients
do not see it or feel it.
• Red indicator band confirms that the
shield is locked and the needle has
been used.

9. I-port
• I-Port Advance injection port
used to give insulin SC
without having to puncture
the skin for each shot.
• It’s easy to apply and easy to
use.
• The port can be worn for up
to 3 days and during all
normal activities, including
exercising, sleeping, and
bathing.

10. Who should consider i-Port Advance
injection port?
• newly diagnosed type 1
diabetes.
• type 2 diabetes and are new to
taking insulin to improve the
transition.
• Anyone who experiences the
emotional challenges of shots
like fear, anxiety, and stress
• physical impact of shots like
bruising, scaring, or pain.
• children and their loved ones,
who often get anxiety when it’s
time to take a shot.

11. Insulin
pump
Insulin pumps are becoming more popular
as the technology improves and additional
features are added.
Continuous subcutaneous insulin infusion
(CSII) is a way to simulate the physiology
of daily insulin secretion 24hrs.
The first CSII pump was introduced in the
market in 1974
Most insulin pumps are small devices
about the size of a cell phone.

12. It provides accuracy and greater
flexibility in insulin delivery for
patients according to their individual
requirements.
Has the ability to accurately deliver
micro doses (0.1 units) of insulin.
It is very expensive as compared to
the use of traditional syringes and
vials.

13. History of insulin pumps
• In 1963 Dr. Arnold Kadish designed the first insulin pump to be
worn as a backpack.
• A more wearable version was later devised by Dean Kamen in
1976.
• The insulin pump was first endorsed in the UK in 2003, by the
National Institute for Health and Care Excellence.

14. • Insulin pump (continuous
subcutaneous insulin infusion) is
increasingly used in the pediatric
population.
• In 2006, there were more than
35,000 patients younger than the
age of 21 years who received insulin
therapy through a pump system.

15. • A position statement of the ADA, ESPE and others recommends that
insulin pump therapy should be considered for patients with one or
more of the following characteristics:
– Recurrent severe hypoglycemia
– Wide fluctuations in blood glucose levels (regardless of HBA1C)
– Suboptimal diabetes control (A1C exceeds target)
– Microvascular complications and/or risk factors for
macrovascular complications
– Good metabolic control, but insulin regimen compromises
lifestyle
• Other situations in which the insulin pump may be helpful include
young children and infants, adolescents with eating disorders,
pregnant adolescents, ketosis-prone individuals, and competitive
athletes

16. • Insulin pumps deliver a basal rate (small aliquots every few
minutes, evenly spaced over an hour) of either rapid- or short-
acting insulin subcutaneously.
• The rate of insulin administration can be transiently increased to
give mealtime or glucose correction boluses.
• Most insulin pump therapy is now started with a rapid-acting
insulin, rather than short-acting insulin.

17. • Insulin is delivered through a subcutaneously inserted catheter that
is replaced at two- to three-day intervals.
• Insulin pumps have not yet incorporated a "closed loop" system in
which blood glucose values are determined and automatically used
to reprogram the insulin pump. Therefore, insulin pump therapy
relies on frequent blood glucose monitoring and appropriate
readjustment of insulin infusion rates either by the patient or
parent.

22. • Data from controlled studies in adults demonstrate the superiority
of intensive therapy compared with conventional therapy in
achieving glycemic control and reducing the incidence of long-term
sequelae.
• One meta-analysis has reported that continuous insulin infusion
(pump therapy) appears to provide slightly better glycemic control
and decreased hypoglycemia than MDI.

23. Beneficial use of insulin pump therapy has been reported in
children as young as 2 years of age.

26. • Insulin pump therapy has also been used in conjunction with a
continuous glucose monitoring device to give the patient more
information about their blood glucose levels and allow them to
make better-informed decisions about insulin dosing; this approach
is known as sensor-augmented insulin pump therapy.

28. • Insulin pump therapy is often preferred by children and their
families. MDI regimens can require as many as six to seven
injections per day, which may be a barrier for some patients and
families.
• An insulin pump can be an attractive option for intensive therapy at
any age.
• Of note, most families with young children who participated in
clinical studies decided to continue with pump therapy even after
the study was completed.

29. • Similar to MDI therapy, continuous insulin infusion therapy
requires:
– frequent blood glucose monitoring
– Carbohydrates counting
– judging the impact of exercise on insulin requirements
– making the appropriate adjustments to insulin infusion rates.
• Without this increased commitment, the benefits of this
regimen are not attained.

30. • Before initiation of insulin pump therapy, the patient and
family must be informed and accept the increased work
required by this therapeutic approach.
• The beneficial effect of the insulin pump is maintained only if
the child and family continue to devote time to carbohydrate
counting and determining appropriate insulin boluses at
mealtime.
Keep in mind

31. • Other considerations regarding the choice of regimen include:
– the greater cost of the pump and its supplies compared to
those of syringes and needles used in MDI therapy
– the complications of pump therapy, such as:
• infusion pump failure
• superficial infection
• minor dermatologic changes such as nodules or scars at
the catheter site.

32. Because rapid- or short-acting insulin is used alone in insulin
pumps and patients have no long-acting subcutaneous depot of
insulin, pump failure can result in rapid onset of DKA. This is
another reason why frequent blood glucose checking is
mandated in children on insulin pump therapy.

33. • Although multiple studies have demonstrated an
improvement of diabetes control with the insulin pump
compared with MDI, decreased adherence to the pump
protocol can occur over time and is associated with
deterioration in control.
• Parental involvement during this time may help offset this risk
in adolescents.

34. References
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diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study.
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2. Klingensmith GJ, Tamborlane WV, Wood J, et al. Diabetic ketoacidosis at diabetes
onset: still an all too common threat in youth. J Pediatr 2013; 162:330.
3. Haller MJ, Atkinson MA, Schatz D. Type 1 diabetes mellitus: etiology,
presentation, and management. Pediatr Clin North Am 2005; 52:1553.
4. Chiang JL, Kirkman MS, Laffel LM, et al. Type 1 diabetes through the life span: a
position statement of the American Diabetes Association. Diabetes Care 2014;
37:2034.
5. American Diabetes Association. 12. Children and Adolescents: Standards of
Medical Care in Diabetes-2018. Diabetes Care 2018; 41:S126.