Q&A: The Challenges, Importance of Insulin Delivery for People with Diabetes

Despite many new innovations in the diabetes space—including continuous glucose monitoring and glucagon-like peptide-1 drugs—insulin delivery remains a crucial intervention for managing the blood glucose of patients with diabetes.

“Resources, including access to health care professionals, are limited and the demand is growing,” wrote authors of a study published in Diabetologia.¹ “Globally, 1 in 10 adults are living with diabetes (537 million) and this number is predicted to rise by 100 million over the next 10 years.”

Isaacs joined Drug Topics to discuss insulin management from her 15-plus years of experience in diabetes care. | image credit:

Amid the growing need for improved diabetes care and better insulin management, Drug Topics caught up with Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, director of education and training in diabetes technology at the Cleveland Clinic. With almost 20 years of experience in diabetes, Isaacs helped us better understand the important role insulin plays in diabetes management.

Read on to learn more about perspectives on insulin management from a certified diabetes expert. Also, be on the lookout for more content from our interview with Isaacs, who discussed the ongoing developments within insulin management and what trends she is expecting to see in the near future.

READ MORE: Pharmacist-Led Telephonic Insulin Titration Significantly Improved A1C

Drug Topics: What is the importance of insulin management for patients with diabetes and how is it currently being administered in the US?

Diana Isaacs: Insulin is very important. Every person with type 1 diabetes (T1D) needs insulin to live. Many people with type 2 diabetes (T2D) need insulin as well. We are seeing that people are being diagnosed with T2D much earlier in their life, like many kids, teenagers, young adults. Even though we have a lot of other great medications to treat T2D, through the natural progression of the condition, a person loses their ability over time to make insulin.

Or there's just so much resistance that, even with other medications, it may not be enough to counteract that, and so then a person needs insulin to be able to maintain their glucose levels. Ultimately, that's very important to prevent any potential types of diabetes complications, including the microvascular and macrovascular complications that could occur.

Drug Topics: For pharmacists and the patients they counsel, what are the biggest challenges regarding insulin management?

Diana Isaacs: Insulin is a very narrow therapeutic window. It's not an easy drug to give and to take. For starters, almost all insulin is injectable. We thought people hated injectables, but turns out with GLP-1s, they're more willing to do it. With insulin, people aren't always so excited to inject. There is one form that is inhaled, so I think that's important to know, but the inhaled form is only for mealtime insulin. Insulin also can be administered through an insulin pump, and that would be fast-acting insulin.

In terms of challenges, what we're trying to do with insulin is to mimic the body's physiologic response. But it turns out, it's very challenging to do that, even with all of the different types of insulins that we have. What can end up happening is, if you don't get the right dose, or you don't have the right timing with the insulin, a person's going to experience hyperglycemia or hypoglycemia.

READ MORE: Insulin Management Resource Center

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Reference

Boughton CK, Hovorka R. The role of automated insulin delivery technology in diabetes. Diabetologia. 2024 Oct;67(10):2034-2044. doi: 10.1007/s00125-024-06165-w. Epub 2024 May 13.