Insulin is an important hormone in the body because it is produced by the pancreas in order to allow cells to utilize sugar (glucose) molecules in the bloodstream for either energy or storage. However, what happens when the pancreas is not able to function properly?
Diabetes is a condition that occurs when the pancreas either is nonfunctional (Type I diabetes) or partially functional (Type II diabetes) which leads to high amounts of glucose in the bloodstream. It is estimated that 37.3 million Americans (11.3%) of the population in 2019 had diabetes and out of that amount 8.5 million were undiagnosed. Diabetes is serious because it can further lead to complications of the heart, kidneys, eyes and even can cause amputations of feet as well.
When it comes to treatment of diabetes, there is a slight difference when treating Type I versus Type II. For Type I, outside (exogenous) insulin is needed since the pancreas cannot produce insulin at all. For Type II, however, insulin may be needed depending on the severity of the patient’s hemoglobin A1C and blood glucose levels, otherwise noninsulin oral and injectable antidiabetic drugs are typically the staple of treating this form of diabetes.
Insulin treatment typically comes in injection form, where the patients inject below the skin, or subcutaneously, and can either inject in the morning, bedtime or before meals depending on if it is a long-acting or fast acting insulin. In addition, patients, especially if they have Type I diabetes, might prefer continuous glucose monitors (CGM). CGMs basically work as both an insulin pump and glucose meter (glucometer). CGMs, such as Dexcom, both monitor glucose levels in the blood and depending on the readings will automatically inject insulin in order to bring the levels back to normal. Many of them will also have alarms alerting patients when their blood glucose is too low. Patients will still have to obtain a prescription for insulin to put in the monitors. Mainly the monitors are attached to the stomach where the insulin vials are injected in and then will go from the monitor into the stomach when needed.
What is V-Go?
V-Go is a disposable, wearable insulin delivery device that delivers continuous basal rate of insulin and also on demand mealtime insulin. However, the unique part about V-Go is that the delivery system is not your usual pump but a credit card-sized patch that adheres to the skin. The best part is that V-Go does not require batteries, infusion sets or programming done by a healthcare provider.
Source: https://www.mdpi.com/2226-4787/8/4/215
How can V-Go be worn?
This can be worn either on the stomach or on the back of the arm as long as there are no signs of irritation, infection or excess hair. The fast acting insulin will be administered with a touch of a button on the patch before meals to cover any blood glucose spikes that are experienced after meals. V-Go is to be worn day, night and during any condition. Therefore patients can shower and swim with it on as well. However, the only times it needs to be removed are during imaging tests, such as X-rays and MRIs, and also if going in a hot tub, sauna and jetted tubs. Also it should be worn under clothing and not be exposed to the sun.
What insulin dosages can the V-Go administer?
There are currently three versions: V-Go 20, V-Go 30 and V-Go 40 and each deliver a certain amount of units per 24 hours.
- V-Go 20 delivers 20 units of insulin per 24 hours
- V-Go 30 delivers 30 units of insulin per 24 hours
- V-Go 40 delivers 40 units of insulin per 24 hours
V-Go 20 requires two vials of U-100 insulin per prescription and both V-Go 30 and V-Go 40 require three vials of insulin. Only fast-acting insulin approved for V-Go is Humalog (insulin lispro) and Novolog (insulin aspart). One push delivers two units of insulin and only up to 18 clicks (36 units) per day of bolus (as needed) insulin. Therefore after 18 clicks, the bolus delivery will pop out and lock to prevent future bolus deliveries for the day.
What are the side effects and warnings associated with V-Go?
The main side effects associated with V-Go are skin irritations that are mainly caused by the adhesive of the patches. Also infection or abscess may occur with the patch if skin is extra sensitive and at this point it is better to remove the patch and place it on a different area of the skin. Rotating areas each time a new patch is applied will prevent these side effects from occurring.
As far as warnings are concerned, there is a risk of hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose). This product would not be appropriate for patients who have to frequently change their long-acting and fast-acting insulin. Therefore while on V-Go it is advisable to monitor blood glucose levels at least two to three times a day and to watch out for signs of hypoglycemia, shaking, sweating and dizziness are typically experienced the most.
All in all, the V-Go patch is a safe and effective way to control glucose levels in patients with uncontrollable diabetes. An insulin pump that is a patch is a very innovative way to deliver insulin and it may be convenient for patients who do not want to worry about batteries or having to see their physician to set their devices. There might also be less pain associated than with traditional insulin delivery when syringes and needles are used. Technology will continue to help advance medicine for many years to come.
Reference:
- Barbie Cervoni MS, R. D. (2021, August 25). Should you try V-go? an insulin pump patch for type 2 diabetes. Verywell Health. Retrieved April 2, 2022, from https://www.verywellhealth.com/what-is-an-insulin-patch-pump-1087254#toc-dosage
- Lajara, R., Fetchick, D. A., Morris, T. L., & Nikkel, C. (2015). Use of V-GO® insulin delivery device in patients with sub-optimally controlled diabetes mellitus: A retrospective analysis from a large specialized diabetes system. Diabetes Therapy, 6(4), 531–545. https://doi.org/10.1007/s13300-015-0138-7
- National Institutes of Health. (n.d.). VGODISPOSABLE insulin delivery. U.S. National Library of Medicine. Retrieved April 2, 2022, from https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=30610026-4fa7-45a1-96a5-41e9e1a278eb&type=display#S2P3-5
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