Insulin Therapy in Type 2 Diabetes - Episode 16
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: We’ve talked about diabetes technology, we’ve talked about insulin pumps, and we’ve talked about CGM [continuous glucose monitoring]. One thing I’m excited about is smart insulin pens. As many of you know, InPen is the only FDA-cleared smart insulin pen system on the market. Diana, you and I have published a lot on this. We were talking about this before it was a thing. I’d love if you could walk us through what it is. I’ll sometimes talk about it, and people ask, “What is it?” Help us understand what the InPen is, then talk about that connectivity and how this aggregates that data. It gives you the ideal dashboard that you would want as a clinician.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: I’ve been using InPen for a while. They were previously owned by Companion Medical, and it is now part of Medtronic’s portfolio. It’s great because it helps people calculate doses, and it records doses for people who are on multiple daily injections.
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: Let me stop you there for a second. That sounds like super sci-fi. Think about explaining that to a patient when they’ve been using the vial and syringe. You’ve now given them a pen, and they’re like, “Oh my god, this is great.” We’re to the point where you’re telling me that the pen is going to do some of this work for that patient. That’s the thing to unpack right there with that. Talk about that true patient burden being shifted onto the device.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: There’s a smart app that is connected to the smart pen, and within that app, you can customize the settings. This is meant for mealtime, rapid-acting insulin. It can be used with Humalog [insulin lispro], NovoLog [insulin aspart], or Fiasp [insulin aspart]. You can customize the app for carbohydrate counting, mealtime estimates, or to set doses. All that can be decided upon. Similar to an insulin pump, it keeps track of active insulin, meaning if a person recently gave an insulin injection, it tracks that. So if they want to give more, it’s going to say, “Wait. It’s too early to give more.” The neat thing about it is that, when you give the injection through the pen, the app knows. It knows how much you gave. If it recommended that you give 8 units, and you only gave 6 units, it knows and it’s going to show up on that report. You know what else it knows? It even knows the priming doses. We recommend that patients do a 2-unit priming dose before their injections. It knows if that was given, and it knows that it wasn’t part of the regular dose.
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: Where was this when we were looking for that lie detector test when we were asking the same question to our patients 2 or 3 different ways to see if we would get a different answer. You now have a source of truth.
Diana Issacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: You have a source of truth. It’s good truth for clinicians, and it’s good truth for patients because in that scenario where they say, “I don’t know if I gave my dose or not,” they can look in their app and see whether they give their dose or did they not give their dose. There are other neat features too. There is a temperature sensor. We know that if insulin gets too hot, it can spoil the insulin. Speaking of lie detectors, it keeps track of whether 28 days have passed and the insulin has expired. It knows, and it will alert the person. It’s got all these cool features.
The reports that it creates are also similar to what we see with insulin pump reports where we get a breakdown of the person’s basal insulin and their bolus insulin. You can see when they gave their doses. It can be paired with blood glucose monitoring or continuous glucose monitoring. One of the neat things about Medtronic acquiring the InPen is that it’s now compatible with the Guardian Connect CGM. Previously, it was compatible with Dexcom, but 1 of the downsides with the Dexcom compatibility was that there was a 3-hour delay. Now, with Guardian Connect, the app updates in real time.
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: You’re saying that the pump is talking to the CGM and is talking to the pen?
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: It’s separate from the pump. It’s the CGM. The Guardian Connect is the standalone CGM. The person would be wearing that CGM, which is communicating to that smartphone app, so that can be used. You can see those numbers in the report when you go to download it, and the person is certainly aware of those numbers and can be using that for correction doses, for their sensitivity factor, and for other things.
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: With what I was saying about it talking, the data from all of it is being seen together, and you can make informed decisions because you have all that data of the insulin doses, skipped doses, insulin on board, and all that stuff. Previously didn’t have access to that information.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: Exactly. It’s key because with some of the CGM systems, you can ask a person to log their insulin doses, but that is so inconvenient. We’re asking a person to keep track and remember to record it. Even when I have patients do that, when it’s not there, I don’t know if they forgot to record it or if they didn’t take the insulin dose.
Dhiren Patel, PharmD, CDE, BC-ADM, BCACP: Sure.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: With the smart pen, you don’t have to worry about any of that because it’s connected. If the dose isn’t there, then they didn’t take the dose, and you know that. The other good thing is that you don’t even need to be near the smartphone. Even if you’re a block away, once you get back to that smartphone, it will have that dose recorded. It is a neat technology for people on multiple daily injections, so it’s a good option for people on multiple daily injections. For some people, it even serves as a segue. They try this. I’ve had a lot of patients who do the InPen, and they’re like, “I like this. I like that smart technology. Tell me more about those insulin pumps.”