Insulin delivery using a needleless injection system? Inconceivable!

Patients who do not have the option of managing diabetes with oral hypoglycemics need to rely on exogenous insulin for glycemic control. Since the development of insulin over 100 years ago, many changes have been made to formulations and administration for patient convenience and better management of diabetes.1The use of insulin pens and syringes involves skin penetration and has been known to invoke pain and patient anxiety, leading patients to reduce or avoid treatment with insulin altogether.1-3 In addition, patients have been known to reuse needles to reduce cost, which may increase the amount of pain on injection or the chance of infection at the injection site. This practice can also increase the chance of blood regurgitation into the insulin cartridge, leading to contamination.2 In an attempt to overcome the anxiety of injection, patients may ignore injection site rotation, which may lead to subcutaneous fat hypertrophy and poorer glycemic control.1Needleless injection system now available in CanadaInsuJet, a needleless system that uses a high-pressure stream of liquid instead of a needle to deliver insulin, is now approved by Health Canada and has been marketed as of November 2024.4InsuJet has been reported to deliver insulin into the subcutaneous adipose tissue with over 90% efficiency.2,5,6 Jet injectors provide a needle-free alternative to use of pens or syringes and are associated with reduced pain, making them ideal for those with needle phobia.3,6 In one study, 95% of jet-treated patients did not experience anxiety with device use and 93.8% successfully completed the trial with the jet injector.2How does the system work?The InsuJet system is composed of three key constituents: an injection chamber for the medication, a nozzle and a pressure source that produces a high velocity jet stream of liquid.6By pushing liquid under high pressure through a tiny orifice in the front of a nozzle, placed on the surface of the skin, InsuJet has the ability to deliver insulin at a velocity of more than 100 m/s through the skin and into subcutaneous tissue.1,2,6,7 In doing this, the insulin is distributed over a larger area in comparison to syringes or pens. The diffusion pattern in the subcutaneous tissue helps to enhance the absorption of insulin into the blood circulation; it also helps to achieve a more direct blood glucose lowering effect.1,7What are the benefits?By improving and accelerating the absorption of bolus insulin from the subcutaneous tissue into the blood, the peak insulin level is achieved within a shorter period of time and the effect of the bolus insulin is similar to that of endogenous insulin.1-3 Treatment with InsuJet showed significant decreases in glucose levels at 30 minutes, one and two hours after administration in comparison to insulin pen use.2,5 As well, it has been noted that administration of insulin by the needleless injection system reduces both time until peak insulin plasma levels and the time to maximal glucose lowering effect by approximately 50% compared to insulin pens/syringes.3 This helps to correct postprandial hyperglycemia, leading to the prevention of serious medical complications including diabetic ketoacidosis and hyperosmolar hyperglycemic state. For those patients on larger doses of insulin, the dose is more readily dispersed into the subcutaneous tissues reducing the need for the patient to repeat the injection, leading to a lower chance of late hypoglycemia.3,7Which patients will benefit from InsuJet?The InsuJet system is suitable for patients with type 1 or type 2 diabetes and can be used to administer any type of insulin, including rapid-acting insulin analogs, regular or NPH insulin, long-acting insulins (glargine, detemir, degludec) and premixtures (e.g., 30/70).8 It is safer than conventional insulin therapy due to the absence of needles and the faster uptake of insulin compared to using pens or syringes. It is suitable for adults and children six years or older of any size or gender. InsuJet can be used in patients with any skin thickness, as there is no correlation between skin thickness and the time for insulin to reach its peak action.The cost to the patient will be approximately $1 per day (excluding the cost of the insulin). The system can be used for up to 5,000 injections and can deliver between 4 and 50 units of insulin per dose. A separate device is needed for each type of insulin. InsuJet is easy to use by installing the nozzle, charging the device, withdrawing insulin from the vial, cartridge or pen, adding a comfort ring and injecting. Adapters are available to connect the nozzle to the insulin container; they are customizable to each product format of insulin (vials or cartridges).8Final thoughtsInsuJet shows promise for increasing adherence in patients using insulin, especially those that have needle phobia or experience pain upon injection. In addition, healthcare providers are at no risk for needle stick incidents and the environment benefits as InsuJet use will lead to fewer single-use needles that need to be processed as sharps waste.9 Some patients may feel the cost of the device is a barrier and some may think the device is larger than desired.2Rhonda Roedler is a pharmacist in Calgary, AB. She maintains an ambulatory clinical practice in diabetes.References:Pan Q, Zhang L, Gu A, et al. The absorption of needle-free insulin aspart through jet injector in different body parts of healthy individuals. Front Endocrinol 2022;13:832726.Guo Lixin, Xiao Xinhua, Sun X, et al. Comparison of a jet injector and insulin pen in controlling plasma glucose insulin concentrations in type 2 diabetic patients. Medicine 2017;96:1(e5482).Engwerda EEC, Tack CJ, Galan BE. Needle-free jet injection of rapid-acting insulin improves early postprandial glucose control in patients with diabetes. Diabetes Care 2013;36:3436-41.Health Canada. Medical devices active licences search. InsuJet. (accessed March 31, 2025).McHugh AD, Chase JG, Knopp JL, et al. Determining losses in jet injection subcutaneous insulin delivery: a model based approach. J Diabetes Sci Technol 2023;17(4):1016-28.de Wit HM, Engwerda EEC, Tack CJ, et al. Insulin administered by needle-free injection corrects marked hyperglycemia faster in overweight or obese patients with diabetes. Diabetes Obes Metab 2015;17:1093-9.Han HS, Hong JY, Kwon TR, et al. Mechanism and clinical applications of needle-free injectors in dermatology: literature review. J Cosmet Dermatol 2021;20:3793-801.Sol-Millennium. InsuJet product information. www.solm.com/insujet (accessed February 28, 2025).Schoppink J, Fernandez Rivas D. Jet injectors: perspectives for small volume delivery with lasers. Adv Drug Deliv Rev 2022;182:114109.

Insulin delivery using a needleless injection system? Inconceivable!

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RHONDA LYNN ROEDLER

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