Diabetes Care: Exploring Needle-Free Insulin Delivery in the UK

Gone are the days when you need to inject yourself with painful syringes and needles several times a day.

Advancements in diabetes care have given us needle-free insulin delivery systems, a pain and anxiety-free method of taking insulin.

This article will explore the game-changing potential of needle-free insulin delivery and how these methods can make your diabetes care easier.

Insulin delivery is how an insulin dose reaches the bloodstream to regulate blood sugar levels.

It doesn't matter how you take your insulin therapy, whether through insulin injections, an insulin pump, nasal spray, or a conventional insulin pen.

These methods are considered insulin delivery devices, and each has pros, cons, and absorption rates.

When your healthcare provider puts together your diabetes care plan, they consider which insulin administration method is best for your case. They also consider your personal preferences, convenience, and any special requirements.

For example, type 2 diabetics who suffer from Parkinson's disease might have a hard time holding a syringe, so doctors might prescribe an insulin pump instead.

Other diabetics might have a needle phobia, which makes needle-free insulin therapy, such as insulin jet injectors, a better choice.

Insulin is one of the most vital hormones in your body, whether you have diabetes or not. It regulates your blood sugar levels throughout the day, especially at mealtimes when your blood sugar spikes from food.

Insulin takes the excess blood glucose and pushes it into your body cells to be burned for energy. This is important because having high blood glucose levels can lead to organ damage and complications such as heart disease, stroke, kidney failure, and blindness.

Insulin delivery is all about getting the right amount of insulin your body needs at the best absorption rate and time.

For example, if you're about to have a carb-rich meal, take short or rapid-acting insulin a few minutes beforehand. You also need to ensure your insulin delivery method allows for quick absorption so the insulin can reach your bloodstream quickly and start working.

Insulin jet injectors, for example, have fast absorption rates and provide early postprandial glucose control. This means they don't allow your blood sugar to spike too much with food.

These devices can be the key to controlling plasma glucose levels and keeping your diabetes in check.

Despite being the oldest and most common method of insulin administration, traditional syringes have several limitations and drawbacks.

One significant challenge is the risk of injection site reactions, which can cause pain, redness, swelling, and itching at the injection site. This discomfort can lead to anxiety and stress, making it difficult for patients to adhere to their prescribed treatment regimen.

You can minimize injection site reactions by regularly rotating your injection sites between thighs, arms, and abdomen, but it’s still a hassle. A needle-free insulin injector, on the other hand, doesn’t cause irritation because it lacks a needle.

Another issue with traditional insulin therapy is the inconvenience and embarrassment associated with frequent injections. Not only do you have to draw insulin from a vial repeatedly, but you also need to ensure you have your insulin treatment with you at all times.

People with diabetes, especially type 1, often must inject themselves multiple times daily, which can be awkward and uncomfortable, especially in public settings.

An insulin jet injector or insulin pump can be much more discreet than a syringe, allowing you to take your insulin dose in seconds.

Insulin pens can get the job done, but they have limited doses, and you might run out of insulin, unlike some jet injectors, which can be reused up to 5,000 times.

You must constantly rotate your injection site with traditional needles to avoid skin irritation. In addition to being inconvenient, this also results in poor glycemic control because different body parts have different insulin absorption rates.

These fluctuations can lead to sporadic blood sugar levels, which makes it difficult to control your diabetes.

Diabetes UK warns people with less body fat (small body mass index) against injecting insulin into their upper arms since there’s a high chance of being injected into muscle tissue rather than subcutaneous tissue.

Muscle tissue has a much faster absorption rate, and injecting short-acting insulin, such as regular human insulin, might cause hypoglycemia (low blood sugar).

This is unlikely with other devices, such as insulin jet injectors, because they’re designed to only reach the subcutaneous layer and no further.

There are several types of needle-free injection devices, each with unique advantages and disadvantages.

Here are a few needle-free delivery systems your healthcare provider might consider.

Needle-free jet injectors are arguably the best and most popular delivery system for people who dislike needles.

They provide an easy method of taking your insulin injections without the pain, skin irritation, and technical difficulty of traditional syringes.

While some diabetics think jet injectors are complicated, they’re actually quite easier to use than syringes or other devices.

Most jet injectors are composed of three main parts:

• A delivery device that looks like a pen 
• A disposable injector nozzle 
• A disposable adaptor that holds an insulin vial 

Jet injectors rely on a compressed spring or gas cartridge instead of using a needle to penetrate the skin and deliver your insulin dose. The spring-loaded mechanism is much more common because it’s lightweight, inexpensive, and more efficient.

When the spring mechanism is loaded, it pushes your insulin dose out at a very high speed, under high pressure, in the form of a fine jet steam. This jet stream is so fine because of the high pressure it enters your skin through the pores rather than penetrating it as a needle would.

The insulin jet stream travels through your skin layers until it reaches the subcutaneous layer and disperses. 

The insulin dose doesn’t just stay in one spot until absorption, unlike with traditional syringes.

Instead, the insulin is distributed and dispersed in a small subcutaneous tissue area, leading to better, more uniform absorption.

Studies show that insulin jet injectors may be more effective than other insulin delivery systems.

For example, a 2017 study was carried out where type 2 diabetics were split into two groups, and a randomized clinical trial was carried out. The first group used an insulin pen, while the other used an insulin jet injector.

The patients used regular human insulin and rapid-acting insulin. The idea was to see how the different delivery systems would affect patients' blood glucose and insulin levels.

Ultimately, the trial proved that the insulin jet injectors group had better control over their insulin and blood glucose levels.

In a few cases, the jet injectors worked too well, and the blood glucose level dropped a bit, but this was quickly reversed when the patients ate.

An earlier 2013 study also showed similar results. Patients who used an insulin jet injector had fewer spikes in their sugar levels following meals compared to insulin pens.

•  More comfortable for self-injection: Insulin jet injectors are more comfortable using traditional syringes because the jet stream is smaller than most hypodermic needles. 
• Easier administration: Jet injectors are easier to operate than traditional syringes, especially for those who have difficulty using needles or have dexterity issues. 
• Faster acting: Insulin delivered via jet injector starts working faster than traditional injections, giving you more control over your blood glucose and insulin concentrations. 
• Reduced anxiety: Jet injectors are a less intimidating alternative to syringes for people with needle phobia. 
• Improved accuracy: Jet injectors come with predefined dose settings and increments, which makes your insulin doses more accurate. 
• Cost-effective: While initially more expensive than traditional syringes, jet injectors can ultimately save money in the long term since they are reusable and minimize waste.

• Limited availability: Jet injectors aren’t widely available in some regions, especially developing countries. 
• Higher upfront cost: Jet injectors have a higher upfront cost than traditional syringes or pen needles, although the long-term investment offsets the initial cost.

InsuJet is an example of an insulin jet injector that revolutionized the concept of needle-free injection.

It improved on the basic idea of a jet injector by incorporating the following features:

• Dosing increments: InsuJet offers a wide dose range of 4-50 units with 1-unit increments, which gives you more flexibility and accuracy with your insulin doses. 
• Jet stream diameter: It produces a jet stream with a diameter of about 150 μm, thinner than two sheets of regular paper. This makes it virtually painless and provides better absorption. 
• Faster absorption: Studies showed that InsuJet lowers your post-meal blood sugar up to 45 minutes faster than traditional insulin syringes. 
• Reusability: The InsuJet device can be used for up to three years or approximately 5,000 insulin injections before you need to replace it.

Insulin inhalers are a needle-free method of delivering insulin directly into the lungs, quickly absorbing it into the bloodstream.

These devices use a dry powder formulation of insulin that is inhaled through a mouthpiece, much like an asthma inhaler.

The concept of inhaled insulin has existed since the 1990s, and the first FDA-approved inhaler came out in 2006. However, it didn’t catch on with diabetics, and a year later, it was taken off the market.

In 2014, Afrezza, another FDA-approved insulin inhaler, was approved for diabetes but only before meals to control mealtime blood glucose.

Today, most insulin inhalers contain either rapid or short-acting insulin, and there aren’t any long-acting formulations of inhaled insulin.

This means diabetics taking inhaled insulin still need to take intermediate or long-acting insulin injections to control their blood sugar throughout the day.

• Fewer injections: While you still need basal insulin injections, inhaled insulin is a substitute for bolus insulin doses (mealtime doses). 
• No refrigeration: Inhaled insulin comes in dry powder form and doesn’t need to be kept in the fridge. 
• Non-invasive: Inhaled insulin is a great non-invasive alternative for people with needle phobia.

• Sporadic absorption: Insulin doses might not be fully absorbed depending on the blood flow and the integrity of your lung cells. 
• Side effects: Cough and sore throat are commonly reported side effects of inhaled insulin. 
• Training: Inhaled insulin requires training to learn how to breathe in the powder correctly so that it reaches the lungs and doesn’t stay in your mouth.

Transdermal insulin patches are another needle-free insulin delivery method. Much like a nicotine patch, you stick it onto your skin, and the insulin passes through your skin layers to be absorbed.

Insulin patches usually have a set number of doses and must be replaced regularly when the doses are finished.

Some patches are designed to release bolus insulin doses at mealtimes, while others provide a steady release of insulin day and night.

The former are called bolus insulin patches, while the latter are called basal insulin patches. Transdermal patches are currently in development as scientists are working on making the insulin molecules smaller so they can pass through the skin.

• Discreet: Patches can be concealed beneath your clothes. 
• Easy to use: Insulin patches don’t require training or technical skills. 
• Reduced risk of infection: Transdermal insulin patches don’t break the skin, so there’s less risk of infection compared to injections or insulin pumps.

• Frequent replacement: Patches carry limited insulin doses and must be regularly replaced. 
• Risk of detachment: There’s always a risk the patch might accidentally detach from your skin, especially during exercise, leading to missed doses.

The era of needles and syringes may soon be behind us.

As needle-free insulin delivery becomes more accessible, more diabetics are switching to these easier, pain-free alternatives.