J Korean Diabetes.  2023 Dec;24(4):190-198. 10.4093/jkd.2023.24.4.190.

Smart Insulin Pen: Managing Insulin Therapy for People with Diabetes in the Digital Era

• Yoo JH
• Kim JH

• KMID: 2550158
• DOI: http://doi.org/10.4093/jkd.2023.24.4.190

Abstract

The number of insulin users in Korea has doubled over the past 20 years. Numerous studies have shown the benefits of continuous glucose monitoring (CGM) on glycemic outcomes in people with diabetes receiving insulin therapy. However, patients often failed to reach the target even with the CGM. Advanced technology, such as automated insulin delivery (AID), can potentially reduce patient burden and improve glycemic status in people on insulin therapy. However, wearing a CGM all day and complex device operation could also burden users. Additionally, since insulin users are often elderly with type 2 diabetes, there is an urgent need for new devices that are more efficient and simpler than AID. In that sense, the smart insulin pen (SIP) is the expected future technology that does not need to be worn all day and helps to calculate insulin doses with a built-in bolus calculator integrated with CGM. In this context, we discuss efficient use of SIP as an educational tool.

Keyword

Diabetes mellitus, type 1; Diabetes mellitus, type 2; Digital technology; Insulin pens

Figure

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  Fig. 1. Combining continuous glucose monitoring (CGM) and smart insulin pen (SIP) can help identify different causes of hyperglycemia. (A) CGM alone cannot determine the causes of hyperglycemia. (B) By combining CGM and SIP, the causes of hyperglycemia have been discovered (mistimed). (C) By combining CGM and SIP, the causes of hyperglycemia have been discovered (missing bolus dose). (D) By combining CGM and SIP, the causes of hyperglycemia have been discovered (mismatch of insulin to carbohydrate ratio [ICR] or carbohydrate counting).

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  Fig. 2. Combining continuous glucose monitoring and smart insulin pen can create a valuable educational tool. (A) Noodles with a high glycemic index (GI) can cause hyperglycemia even with proper insulin use. (B) Exposure to hypoglycemia is inevitable when increasing bolus insulin to avoid post prandial hyperglycemia after consuming high GI foods. (C) Administering a small amount of bolus insulin (1 to 2 units) 30 minutes to one hour before a meal can prevent postprandial hyperglycemia (pre-bolus). (D) Eating protein before consuming carbohydrates can slow the increase in blood glucose level. (E) Consuming high-fat foods, like pizza, can cause blood glucose level to remain elevated for up to 12 hours. (F) When consuming high-fat foods, an additional 30% bolus of insulin may be helpful 1∼2 hours after the meal.

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  Fig. 3. Whether use of the bolus calculator can affect glycemic outcomes. (A) The risk of hypoglycemia increases when not considering insulin on board (IOB), so it is essential to use a bolus calculator that factors in IOB. (B) Hypoglycemia can be prevented by reducing the bolus insulin dose and considering IOB using a bolus calculator.

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  Fig. 4. Smart insulin pen allows insulin dosage based on meal size (meal estimation). (A) Using the meal estimation method, insulin dose can be based on meal size. (B) Clicking ‘dinner’ and ‘low-carb’ will inject 3.5 units. Final dose varies based on insulin on board (IOB) and insulin correction factor.

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