Insulin administration devices

What insulin administration devices are there and what different types of insulin are available ... 

II.f.1.3. Insulin delivery. Traditionally insulin was given intramuscularly and later subcutaneously. New technology has provided devices for insulin administrations including pen-devices, air powered injectors, external insulin infusion pumps (or continuous subcutaneous insulin infusion, CSII), and implantable insulin infusion pumps. Some novel forms of insulin delivery have been introduced, for example intranasal insulin gives peak insulin concentrations at 10-20 minutes after administration, but most insulin is still administered subcutaneously. 

Salem JL, Charles MA. Devices for insulin administration. Diabetes Care 1990 13 955-979. 

Controlled parenteral delivery of proteins has recently been reviewed by Pitt (1950) and Heller (1993a,b). Developments in insulin delivery systems have been reviewed by Saudek (1993), devices for insulin administration by Selam and Charles (1990), and subcutaneous insulin therapy by Houtzagers (1989), Home and Alberti (1992), Koivisto (1993), and Heine (1993). 

Mechanical devices for insulin administration have been reviewed by Selam and Charles (1990). 

A number of external or internal pumps have been developed as insulin infusion pumps, or an artificial pancreas, which gives a more precise control over the body s insulin level. These devices normally inject the insulin solution directly into the patient s blood. Many of these "artificial pancreas devices are able to vary the rate of insulin administration, and much progress has been made to couple these pumps with a microprocessor controlled glucose sensor which would closely approximate normal pancreatic activity. Most of these infusion pumps utilize poly-(dimethylsiloxane). 0,41... 

Insulin pump therapy consists of a programmable infusion device that allows for basal infusion of insulin 24 hours daily, as well as bolus administration following meals. As seen in Fig. 40-3, an insulin pump consists of a programmable infusion device with an insulin reservoir. This pump is attached to an infusion set with a small needle that is inserted in subcutaneous tissue in the patient s abdomen, thigh, or arm. Most patients prefer insertion in abdominal tissue because this site provides optimal insulin absorption. Patients should avoid insertion sites along belt lines or in other areas where clothing may cause undue irritation. Infusion sets should be changed every 2 to 3 days to reduce the possibility of infection. 

With regard to the systemic administration of smaller proteins (<20 kDa), the development of insulin for inhalation has shown that the pulmonary route is a feasible route of administration. However, advanced inhalation devices and formulations were required to obtain a reproducible lung deposition. It will be especially necessary to deal with the problems that occur when drugs with a small therapeutic window are administered. To enable widespread use of the lung as port of entry for these small proteins, future developments should be directed towards more simple inhalation devices which still give a high and reproducible lung deposition. The formulations that will be required for these proteins are likely to be much more complex and advanced than those that are currently used. Examples are formu-... 

By the use of a breath-powered unit dose dry powder inhaler, which was adapted to the physical properties of TI, relative bioavailability was 50% for the first 3 hours and 30% over the entire 6-hour period in 12 healthy volunteers (Pfutzner et al. 2002). However, although the studies demonstrated pulmonary administration of TI has the advantages of fast onset of action, short duration of action, and lower variability over the SC injections of insulin no attempt has been made to compare pulmonary administration of insulin alone with the same inhaler device. This method of encapsulating biomacromolecules has some advantages and must be considered when electing to deliver a molecule. 

Rare complications are lipoatrophy or hjrpertrophy and insulin edema. Insulin has to be given by injection, with pumps or specific devices for intensive therapy, which all generate specific problems. Other ways of administrating insulin are still experimental. 

Microspheres prepared from hyaluronan esters have been evaluated for the vaginal administration of calcitonin in the treatment of postmenopausal osteoporosis. Microspheres prepared from hyaluronan esters have also been used experimentally as delivery devices for nerve growth factors, and as a nasal delivery system for insulin. ... 

All subjects were assessed over four test periods, 3 to 14 days apart, to determine dose-ranging effects and pharmacodynamics by euglycemic clamp, and insulin pharmacokinetics over 6 hours. Oralin administration on the three study days was in randomized order. Each subject was provided with the placebo device to practice the administration technique as taught by a video demonstration. The Ora-lin device comprises a standard MDI device with certain proprietary modifications to deliver the insulin into patienfs mouth. A simple procedure was used for Oralin dosing patients were asked to position the device in their mouth and to spray the Ora-lin formulation by depressing the device once. Patients were asked not to exhale or... 

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