# Smart Insulin Pens For Today And The Future



## Northerner (Oct 1, 2018)

When NovoPen by Novo Nordisk hit the market back in 1985, this first FDA approved insulin pen changed the way millions of people managed their diabetes. As pens have developed over time, “smarter” products have begun appearing. Lilly’s HumaPen Memoir came out in 2007 with a data memory for up to 16 doses. Then came the Timesulin pen cap, aiding users in keeping track of their last injection. Novo Nordisk came out with their Echo pen in 2014 with memory function as well as half-unit dosing, allowing even more control for users.

Technology continues to move at break-neck speed, resulting in significant improvements for the newest generation of insulin pens. Smart pens offer many benefits of an infusion pump without the disadvantages. Far beyond only keeping track of data, smart pens combine the aspects of injector pens, bolus advisors, Bluetooth technology, and smartphone apps.

https://asweetlife.org/smart-insulin-pens-for-today-and-the-future/

$500?  That'll be a 'no' from NICE then


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## mikeyB (Oct 1, 2018)

It’ll be a no from me, never mind the cost. I don’t need a smart pen as long as I have a brain that works.


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## Flower (Oct 1, 2018)

Is there a reason why the smallest dose of insulin at present via pen is 0.5u? Are smaller doses not accurately deliverable via pen needle? Needles go into the same subcutaneous layer as my pump cannula sits in so what is stopping smaller increments being available. Just a thought- I'm probably missing something obvious!


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## Northerner (Oct 1, 2018)

Flower said:


> Is there a reason why the smallest dose of insulin at present via pen is 0.5u? Are smaller doses not accurately deliverable via pen needle? Needles go into the same subcutaneous layer as my pump cannula sits in so what is stopping smaller increments being available. Just a thought- I'm probably missing something obvious!


Perhaps the extra costs of fine-engineering it for smaller doses isn't worth the expense if the demand isn't there? It always amazed me that the Autopen 24 I used to have for my lantus could ever administer doses to a 2-unit accuracy, given how cheap and clunky it felt!


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## Lanny (Oct 1, 2018)

Just a thought, @Flower, Is it something to do with the dilution? Both my Novorapid & Levermir pens say, on the side, 100 units/ml so, 3ml of liquid in the 300 units pens & within that 3ml there are 300 units.

In aroma therapy you NEVER use the oils without diluting it in a carrier oil before using on the skin, usually 1ml of oil to 10ml of something like castor oil. Most oils are already diluted in a carrier oil for safety & convenience!

So, I'm thinking does insulin need to be diluted in a carrier liquid? If so, how far can you dilute it?

Just a though! I don't know if any of this is right!


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## Robin (Oct 1, 2018)

Northerner said:


> Perhaps the extra costs of fine-engineering it for smaller doses isn't worth the expense if the demand isn't there? It always amazed me that the Autopen 24 I used to have for my lantus could ever administer doses to a 2-unit accuracy, given how cheap and clunky it felt!


I suspect it's demand. There was obviously a demand for more concentrated insulin for those on high doses, hence Toujeo. It ought to be possible to do it the other way, and produce a more dilute insulin for those who need a quarter unit dose. (I know there have been times when I wished I could dose in between 2.5 and 3 for my night time basal!)


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## Lanny (Oct 1, 2018)

Robin said:


> I suspect it's demand. There was obviously a demand for more concentrated insulin for those on high doses, hence Toujeo. It ought to be possible to do it the other way, and produce a more dilute insulin for those who need a quarter unit dose. (I know there have been times when I wished I could dose in between 2.5 and 3 for my night time basal!)



Ah! I'm right then? Insulin IS diluted. More dilution would result in either bigger pens or less units in each pen or cartridge!


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## Bruce Stephens (Oct 1, 2018)

mikeyB said:


> I don’t need a smart pen as long as I have a brain that works.



My brain works OK, but I'm still glad I bought one of the simple timer add ons for my basal doses. It means the pen's a bit different (so I'm less likely to inject Novorapid by mistake) and it means when something in my routine changes, I don't need to try and work out whether I've already given the basal dose or not. Nothing vital, I think, but I think there's value in some similar minor changes.

I'm also sceptical that having bluetooth-enabled pens would be worth the cost, but then I have an ordinary (non-internet enabled) fridge, and electric toothbrush. Maybe there's enough to make them worthwhile for some people.


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## Flower (Oct 1, 2018)

As tech keeps getting smarter encouraging and enabling tighter control then perhaps that would generate a demand for smaller deliverable doses via pens to maximise control.  My pump uses u100 insulin for tiny 0.025u increments as well as larger doses so why would insulin need to be more dilute if pens were capable of delivering a smaller dose. Hhmm...


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## Bruce Stephens (Oct 1, 2018)

Flower said:


> My pump uses u100 insulin for tiny 0.025u increments as well as larger doses so why would insulin need to be more dilute if pens were capable of delivering a smaller dose.



I imagine it's just the difference in plumbing. A pump can reasonably provide continuous small doses over a long time, and changing that in small increments makes sense. With a pen, I imagine half a unit (or a unit, for that matter) is close to the limit of practicality.


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## Robin (Oct 1, 2018)

Flower said:


> As tech keeps getting smarter encouraging and enabling tighter control then perhaps that would generate a demand for smaller deliverable doses via pens to maximise control.  My pump uses u100 insulin for tiny 0.025u increments as well as larger doses so why would insulin need to be more dilute if pens were capable of delivering a smaller dose. Hhmm...


I'm sure they could engineer an accurate pen to do quarter units, and it would be more sensible than diluting the insulin. It might be expensive, though, I was just thinking they could do it now, and more cheaply, with diluted insulin, but thinking about how muddled people get trying to fathom out what to do with Toujeo, it's probably too much for people to get their heads round having more dilute as well as more concentrated insulins..and the pens wouldn't last as long if you were just doing it for fine tuning. (I was thinking, I normally throw out my basal cartridge before its used up, because I don't use a whole one in 28 days.)


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## Bruce Stephens (Oct 1, 2018)

Robin said:


> but thinking about how muddled people get trying to fathom out what to do with Toujeo, it's probably too much for people to get their heads round having more dilute as well as more concentrated insulins



We have some idea of that, because before U100 we had a variety of strengths. I seem to remember 20 strength being the base, with 40 and 10 being quite common. So (depending on what the pharmacist had) you might need to do a bit of multiplying or dividing by 2 to get the dose. I seem to remember Agatha Christie killing off a person or two by substituting their insulin with different strengths. (I think nowadays U100 isn't the only strength available; it's just good enough for almost everyone.)


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## mikeyB (Oct 1, 2018)

I can’t see the commercial value of making a quarter unit pen. Or diluting insulin. Lantus and Toujeo are unique in this regard because of the way they work. Lantus gets its long acting effect by forming a gel-like substance under the skin which slowly leaches out insulin. They had to make Toujeo because of the big doses that some T2s need, to avoid build up. (As well as extending the patent). 

I can’t imagine anyone using a quarter unit to fine tune a pen injection, it’s never that exact a science. Folk have lived 50, 60, 70 years  with diabetes without quarter unit pens in the days of animal insulins.


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## Northerner (Oct 1, 2018)

mikeyB said:


> I can’t imagine anyone using a quarter unit to fine tune a pen injection, it’s never that exact a science. Folk have lived 50, 60, 70 years with diabetes without quarter unit pens in the days of animal insulins.


I remember reading once about a parent who treated their child with a pen as though it was a pump, giving lots and lots of very small injections, which most people saw as taking things to the extremes. I suspect the child has grown up with a real complex about injections after that - hopefully they got an actual pump in the end (wish I could remember where I read it - does anyone else remember, from about 8 years ago?)


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## Flower (Oct 1, 2018)

Maybe it's just me then correcting sometimes with 0.1u to get me the right side of 7 or 6. I assumed that a smart insulin pen wouldn't just be the bluetooth part etc but would enable more fine tuning in dosing. The report does say that smart pens offer many benefits of an infusion pump without the disadvantages.  I've probably been living without long acting insulin in my system for too many years and forget it's there in the background for a reason.


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## trophywench (Oct 1, 2018)

IMHO, because MDI is such a very blunt instrument (look at how much LESS insulin most people actually need once they've settled into pumping despite the fact they are getting older, heavier and taking less exercise) then tiny increments shouldn't be necessary.  If a person happens to need tiny doses and therefore increments - then a pump can so easily achieve this - why do they need to invent anything else which 99%+ of MDI-ers won't ever need?


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