Needle Technology for Insulin Administration: A Century of Innovation

Abstract

Innovations in syringe and pen needle (PN) technology over the last 100 years have led to important advances in insulin delivery for people with diabetes, paralleling the strides made in developing recombinant DNA human insulin and insulin analogs with varying onset and duration of action. In this review, the history of advances in insulin delivery is described, focusing on progress in syringe, needle, and PN technologies. The early glass and metal syringes that required sterilization by boiling have been replaced by disposable, single-use syringes or pens with clear labeling for precise insulin dosing. The early needles ranging in length from 19 to 26 mm that required manual sharpening against a whetstone have been replaced by syringe needles of 6 mm and PNs of 4 mm in length as slender as 34 gauge. Imaging studies using ultrasound and computed tomography measured the thickness of skin and subcutaneous tissue layers to show feasibility of targeted insulin administration with shorter needles. These developments, coupled with innovations in needle/PN wall and tip structure, have led to improved injection experience for people with diabetes. It is also important to acknowledge the role of injection technique education, together with these advances in injection technology, for improving clinical outcomes and patient satisfaction. With continued projected growth of diabetes prevalence, particularly in developing countries where expensive and complex insulin delivery systems may not be practical, insulin syringes and pens will continue to serve as reliable and cost-effective means of insulin delivery for people with diabetes.

A Practical Approach to the Initiation, Titration and Intensification of Insulin Therapy in Adults with Diabetes in the Indian Context: Recommendations by Association of Clinical Endocrinologists Consensus Group

“…Glass syringes should be replaced with plastic fixed-needle syringes that have less dead space and are intended for single use [41]. Many people reuse insulin needles for a variety of reasons, including cost considerations [40].…”

Caring for people with diabetes

“…Nurses must periodically review the timing of medications with the other aspects of self-management, such as meals, exercise, and monitoring; assess injection technique; and inspect for lipohypertrophy 2. Evidence supports using short insulin needles (4 mm) with adults, even for those who are overweight or obese 11. The signs and symptoms and “Rule of 15” treatment for hypoglycemia should be reviewed with patients who take insulin and sulfonylureas, as well as the importance of diabetes identification, such as medical-alert jewelry (see Rule of 15s: Treatment for hypoglycemia ) 2.…”

Biodegradable polymeric insulin microneedles – a design and materials perspective review

“…Exogenous INS is the widely accepted standard anti-diabetic treatment option given as subcutaneous (S.C.) injections. Patient compliance to injections is lower due to pain or accidental needle pricks resulting in bleeding or infections from traditional needles, hypoglycemic shock, peripheral hyperinsulinemia, lipodystrophy, obesity, and macro- and microvascular complications (Yang et al., 2018 ; Zhao et al., 2022 ; Heinemann et al., 2023 ). After S.C. INS injection, only 20% of the injected dose reaches the target.…”

“…In addition, MN reduces the probability of microbial penetration and contamination in comparison to traditional needles (Le et al., 2022 ). MN insertion depth is a maximum of 900 μm but the S.C. needle pierces to 4–6 mm (up to 9000 μm) beneath the skin (Heinemann et al., 2023 ). Repeated INS injection administration with a hypodermic needle causes adipose tissue atrophy, skin thickening, nerve damage, tissue necrosis, and ulcerations at the injection site (Zhang et al., 2021 ).…”