Insulin in the News -- by: Kris Kilen, RD, CDE
As all diabetes educators are aware, many times a patients’ first statement upon hearing news of their diabetes diagnosis is a variation on “do I have to go on insulin?” The good news for those who do, the variety and options have been expanding at a rapid rate in the past decade. The down side of that, as many patients learn, is the cost has expanded right along with this.
This blog couldn’t begin to suggest strategies to determine the best course of action for a blanket treatment plan or cost savings when it comes to suggesting an insulin regimen for all. As we know the individualized needs of our patients are directed by both their disease state and process as well as their insurance durability.
But there are trade-offs. Some patients use human insulins for their cost effectiveness. Others navigate formulary insurance plans to use a regimen of insulin analogs that supports their diabetes care. This is an area that diabetes educators can be so useful in team management. Educating patients on insulin use with lower cost human insulin or how a change in formulary could indicate the same insulin type with a different name are strategies that assure continued medication use.
Diabetes Educators are also in unique positions to support use and teaching of new formulations of concentrated insulins. Concentration allows a patient to take units of insulin in a dose of smaller volume than the U-100 formulas they may be used to using. This is helpful from an economic standpoint as well as reduced volume in patients using high dose insulin. A recent pearl from a patient was the excitement of using fewer pens per month, something very important to him. Humalog U-200 Kwikpen is available with a simplistic teaching method of device design that allows that patient to dose the same units as the U-100 formula; what they don’t see is that the volume injected is half the volume of a U-100 dose. In fact, all of the newer concentrated insulins are pen available only. An old insulin new to the pen scene is Humulin U-500, in a prefilled pen that will allow for ease of teaching patient and improve dose accuracy.
Basal insulins also have a place at the concentrated table. Lantus insulin is available in a pen formulated U-300 known now Toujeo U-300. Patients can use the pen device to inject the exact same number of units of lantus, with the design providing 1/3 volume. Tresiba is the newest long-acting insulin and is available in both U-100 and U-200 . Both are prefilled pens, with the U-200 a likely option for those patients needing higher dose insulin.
What’s on the horizon: Basaglar, a biosimilar of lantus expected late 2016. Also a basalin insulin + GLP-1 receptor agonist mix injectable. Available in a fixed-ration combination pen only device, will be a combination lantus + lixisenatide (a GLP-1 receptor agonist with expected FDA approval this Fall.