Diabetes is a complicated disease in which the body cannot create or properly use insulin, a hormone that enables the body to convert sugar, starches, and other food into energy. Loss of vision and damage to nerves, blood vessels, and kidneys are all potential side effects of the disease.
Fortunately, in recent years, scientists have made several treatment breakthroughs, including the introduction of insulin pumps and inhaled insulin (Exubera). Both treatments have advantages and disadvantages, but for many diabetics, they are proving to be successful alternatives to injections that offer convenience, flexibility, and improved quality of life.
Portable insulin pumps, which deliver insulin 24 hours a day through a catheter placed under the skin, were introduced in the early 1990s. In the past two decades, the technology has evolved to the point that now they can be a good alternative to traditional injections.
"Pumps can be a very nice thing for diabetics to have," says Erin Poff, R.N. and assistant department manager at Sparrow Hospital in Michigan. "Not only do pumps inject insulin more accurately than injections; they allow the patients to feel more in control of their disease, enabling them to continue to live their lives more normally."
By continuously administering a basal rate of insulin while allowing boluses of insulin only when the patient needs it, the pump offers many diabetics increased flexibility when it comes to meal plans and greater control of their blood glucose levels. Perhaps best of all, patients don't need to schedule their lives around insulin injections.
Exubera, the first dry-powder inhaled insulin, was approved by the U.S. Food and Drug Administration (FDA) in January 2006 and is used for both type 1 and type 2 diabetes. The medication, which delivers short-acting insulin via an inhaler, is administered two to three times a day just prior to meals, and the dosage depends on the weight of the patient.
"[Exubera] is doing very well," says June Robles, a veteran R.N. of 46 years. "It's more convenient for patients and it doesn't have many more side effects than injected insulin." What's more, "studies on Exubera suggest that it controls blood sugar levels just as well as injected insulin."
At the same time, Robles is quick to note that this treatment isn't for everyone. Exubera does have the potential for causing lung damage because of the deep inhalation process, so patients must have very strong lungs to use this medication. Poff points out another drawback: "There might be an issue with the dosage of insulin because it's only inhaled. It may be hard to know precisely how much of it is actually absorbed by the lungs."
That said, Exubera users have cited additional advantages, including the size of the devices. Exubera powder packets are small, and the inhaler is about the size of a small flashlight, so patients can carry it with them in a purse or briefcase.
Pills, Patches, and Beyond
Along these lines, there are several breakthrough treatments on the horizon that may further revolutionize the way diabetics live and manage the disease. Some of the most eagerly anticipated noninvasive insulin-delivery methods include the skin patch and the insulin pill.
The insulin skin patch is currently under development. According to the FDA: "The insulin patch, when placed on the skin, will give a continuous, low dose of insulin. To adjust insulin doses before meals, users will pull off the tab on the patch to release insulin." Because it's difficult for insulin to penetrate the skin, it is believed that delivery will be aided with sound waves or an electrical current.
Insulin pills would provide insulin in tablet form, and the FDA reports that researchers are working to find a way around this approach's biggest challenge: getting insulin into the bloodstream before it is changed by normal digestive processes. Possible solutions includes using nanotechnology to coat the pills with special polymers so the insulin doesn't get broken down in the stomach.
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