Pens, Pumps, and Plungers: A Quick Guide to Insulin Options

Most diabetics undergo insulin replacement treatment when the beta cells in the pancreas stop producing the hormone that brings sugar into cells. Before the advent of modern medicine, when the beta cells stopped doing their job, that was the end of the road.

Since the 1920s, however, insulin options have been manufactured for people with type 1 diabetes (which occurs most often in young people). Type 2 diabetes can sometimes require insulin therapy as well.

The Progression of Insulin Types

From the 1920s to the 1980s, replacing insulin involved using a syringe to measure out a dosage from a little 10ml vial. This had some advantages. For the regular insulin options, which worked within an hour of injection, the cost was relatively low -- around $50 a vial. As more types of insulin were invented, diabetics could choose the style that best fit their daily lives. Rapid-acting (within 15 minutes), intermediate (within 2-4 hours), and long-acting (within 2-6 hours) formulas became available for about $100 per vial, a cost largely -- if not entirely -- covered by most insurance plans.

Soon, combination insulin medications became available. These mixed-formula insulin options were about 70 percent long-acting insulin and 30 percent short-acting insulin. In some ways, they mimic beta cells because they lower blood sugar levels now and later, over a period of up to 18 hours. This gives a diabetic more flexibility by letting a workday go by without multiple injections, carrying around and disposing of needles, or having to find somewhere to refrigerate their insulin.

A New Convenience: The Insulin Pen

The next stage in insulin evolution came with the invention of insulin pens. Just as ink is carried in a ballpoint pen, insulin pens are loaded with a cartridge containing a certain dosage. The pens can be filled with short-acting, long-acting, or any combination of insulins, and can be pre-filled or refillable. When low amounts are needed, pens provide more accurate injection (which is especially good for kids).

Many people find them more convenient and easier to use. This improves medication adherence -- the rate at which patients take their medicine as prescribed by their doctors. For these reasons, while insulin pens are more expensive, most insurance providers offer similar coverage for pens as they do for vials.

The Latest Improvement: The Insulin Pump

Since the discovery of insulin nearly 100 years ago, one of the most profound inventions has been the insulin pump. It works almost like an external organ; it sits in a pouch near the body and is connected to the blood supply. Instead of relying on timed injections or finger pricks to determine how much insulin is needed, pumps are programmed to inject tiny doses when necessary. Most are manually controlled, but they can be worn with a continuous glucose monitor, which alerts diabetics of high or low blood sugar. Some pumps are waterproof, and others have alarms and Wi-Fi.

Pumps have profoundly improved safety and health benefits for diabetics. A well-maintained and appropriately used insulin pump essentially prevents improper dosing. As a result, Medicare now only covers insulin if it's pump-administered. Most insurances cover the pump, any needed supplies like tubing, and the insulin at the same level or more than insulin pens.

Nearly 10 percent of the U.S. population has some form of diabetes. While not all of these 30 million people require insulin therapy, many do. If you require insulin for diabetes, talk to your doctor about which of these insulin options may be best for you.