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CDE,LD,MS,RD
New V-Go (TM) Disposable Insulin Delivery Device
Section:  General Diabetes

I just read about this new disposable pump for type 2 diabetes today.  

The V-Go is designed to hold 20, 30, or 40 units of rapid-acting insulin (humalog or Novolog is indicated on website) for 24 hrs.  The device delivers a basal rate over 24hrs and delivers bolus on demand for meals.  The site doesn't indicate it but it seems this device is different from a typical insulin pump in that the basal rate is constant, not variable.  And the device is only worn for 24 hrs.  

It is designed for type 2 diabetes only.  It is waterproof, replaced every 24 hrs.

My only reservation is the constant basal rate.  Typically pump wearers end up with 3-6 basal rates over a 24 hr period.  I am unsure how accurate one constant basal rate would be.  But I guess that is basically what is happening when you take a long-acting insulin dose, although those are usually variable even though they are supposed to deliver a constant dose over time.  

The website does have this info on it:

Important Risk Information

If regular adjustments or modifications to the basal rate of insulin are required in a 24-hour period, or if the amount of insulin used at meals requires adjustments of less than 2-Unit increments, use of the V-Go Disposable Insulin Delivery Device may result in hypoglycemia. 

Here is some more info about the device:

  • Preset basal rate and on-demand bolus dosing mimic physiologic insulin delivery
  • Requires only one insulin type (Humalog ® or NovoLog ® )*—no need for additional insulin shots 
  • Easy for patients to fill, apply, and use—no electronics, batteries, infusion sets, or programming
  • Convenient, comfortable, and fully disposable—patients remove and discard the V-Go™ and apply a new filled V-Go every 24 hours
The site says "disposable insulin deliver devices such as the V-Go are reimbursable under the Medicare Part D pharmacy benefit..."  I wonder if this one is.  

Here is the website:

http://www.go-vgo.com/default.aspx


What do you think about this new device?  Have you seen it in use yet?


MEMBER COMMENTS
Re: New V-Go (TM) Disposable Insulin Delivery Device

Hi Micki

Thank you so much for this information, Diabetes care is never boring with the technologies already here and to come that can help our patients with quality of life issues while working to achieve glycemic control.

I just went to the website. It is i nteresting for sure. If it is available, it will probable be at the national American Diabetes Association and American Association of Diabetes Educators meetings. I will surely look for it.

Re: New V-Go (TM) Disposable Insulin Delivery Device

As a patient with T2 on MDI, I would find it hard to justify and use this device.  It only delivers three levels of fixed basal dosing (20, 30 and 40 units/day), none of which meet my need.  What I really need is an overnight basal level that is about three times my daily level to deal with DP.  And I would do better a bolus that had 1/2 unit or at least one unit on a button press.

This device basically is a poor man's pump that implements have "rough" basal-bolus regime.  A well trained and diligent patient could achieve much better control with vial/syringes or pens.  As a patient, if I truly wanted the convenience and was willing to make large compromises on my glycemic control, I would just take a huge basal once a day, never bolus and walk around all day with higher blood sugars and a stockpile of glucose tabs for the hypos.

Re: New V-Go (TM) Disposable Insulin Delivery Device

I was just downloading some information on V-Go as your post came up.  Found it on the epharmacist newsletter.   Seems a very crude approach to "grossly" fix diabetes.  There are many insulin resistant Type 2's though that may like the idea.  You are right, the technology keeps changing and we need to evaluate the worth for (and with) each patient. 

Re: New V-Go (TM) Disposable Insulin Delivery Device

I totally agree!  This is not ideal by any means.  Unfortunately, I anticipate it will appeal to many people.  They just want something to 'do it for them' and this device is basically taking away the injections.  Many people may not care how well it works as long as they don't 'have to stick themselves'.  It is not ideal to have one set basal rate running and I certainly see problems.  There will be a certain niche that this device will apply to but I can guarantee most all of my insulin users will be interested in it, especially if the marketing is what I expect it to be...'are you tired of taking insulin shots...let the V-Go do the work for you!  Never give yourself a shot again!'  I can hear it now.  Sorry, that was cynical.   

I will be interested to hear what questions my patients have about this device once they hear about it.  And I will be very interested to see it at work.  This is exciting!

Re: New V-Go (TM) Disposable Insulin Delivery Device

All great points, my wonderful colleagues. This blog is a wonderful way to assess the usefulness of new products without the hype from the vendors!

 

Since the insulin pumps are approved for type 2 diabetes by Medicare and Medicaid, I am sure they are going to try to plug into that market. My question is, why does it have to be replaced every 24 hours??

 

What really struck me about this whole idea is that there has been much discussion that large amounts of insulin injected in one location may not absorb as well as very low amounts.

Re: New V-Go (TM) Disposable Insulin Delivery Device

Hello Patricia!

You asked a good question about the 24 hour preset use of this pump.

It's my understanding that after 24 hours, the V-Go (20 or 40) may no longer deliver a continuous preset basal rate of insulin. 

Thank you.  

Re: New V-Go (TM) Disposable Insulin Delivery Device

I've seen this product about 5 years ago in development and have been waiting for it to come to market.  Here is another as well.  It takes for ever for these companies to come to market!  Can't wait to see them in AUGUST!

http://cequrcorp.com/cequr-device/

 

Re: New V-Go (TM) Disposable Insulin Delivery Device

In looking at the device, I'm guessing it would depend on how large the "reservoir" is that will hold the insulin.  Some of these don't use an electronic system for delivery, but rather a mechanical system, which makes it function in a much different capacity.

Re: Re: New V-Go (TM) Disposable Insulin Delivery Device

What really struck me about this whole idea is that there has been much discussion that large amounts of insulin injected in one location may not absorb as well as very low amounts.


The V-Go delivers a very small amount of rapid acting insulin in one area over the course of 24 hrs.  Like an insulin pump.  So large amounts of insulin are not being used at one time and the device is changed every 24 hrs to avoid using the same area over and over again.  

Re: New V-Go (TM) Disposable Insulin Delivery Device

The preset doses are: 0.83u/hr; 1.25 u/hr and 1/67 u/hr. All have up to 36 units of on-demand bolus dosing.

The basal set choices are a recipe for hypoglycemic disaster.  I would never recommend this unit to my patients.  None of my patients need that high a dose of basal 24 hours a day. 

 

Re: Re: New V-Go (TM) Disposable Insulin Delivery Device
Quote:

The preset doses are: 0.83u/hr; 1.25 u/hr and 1/67 u/hr. All have up to 36 units of on-demand bolus dosing.

The basal set choices are a recipe for hypoglycemic disaster.  I would never recommend this unit to my patients.  None of my patients need that high a dose of basal 24 hours a day. 


I find this to be an interesting comment.  Bernstein suggests that patients that follow his diet require smaller doses of insulin and as a T2 I have had success with small boluses for meals. But this is not the case with my basal.  My fasting blood sugars are my downfall and I seem to require some 50 units a day in order to normalize my blood sugar. 

What is it that enables your patients to all achieve such dramatically reduced basal insulin requirements?

Re: New V-Go (TM) Disposable Insulin Delivery Device

Thanks, Joan

I had not heard of the CeQur pump before.

The CeQur  disposable pump can be worn for 3 days...better than 1 day for sure

It looks like the pumps without tubing are the wave of the future.

 

The national ADA and AADE meetings are always so interesting whe there are new things to see.  I will surely visit the booths for both pumps

Re: New V-Go (TM) Disposable Insulin Delivery Device

Hey, I think that we should have a get together at the AADE conference!  That way we can meet face to face....now wouldn't that be a hoot.  I have't really looked at the Agenda, and don't yet have my plane...but I did register and will have to find out what hotel I'm at (I hate details of all these programs...)!

 

Re: New V-Go (TM) Disposable Insulin Delivery Device

Hello, Brian,


I use a combination of low CHO, supplements, stress management, exercise training, and such with patients.  Most basal rates for my patients range from 0.35-1.25 throughout the 24 hours, depending on, well, everything.  I could not use any of those preset ones without at some point risking hypoglycemia at some point during the 24 hours in my patients.  My T1DM patients generally use <30 units a day for all their insulin needs, basal and bolus.  Non-diabetic (ie, "Normal") patients use 30-40 units a day for all their glucose regulation, so a diabetic on full insulin should not need more than that themselves.  If they use more than that they are at high risk of developing insulin resistance. 

Obviously, I have no idea why you're basal needs are a bit higher. 

Re: New V-Go (TM) Disposable Insulin Delivery Device

Good point, Micki

 

The amount of insulin going into that one site is far greater than the amount usually injected for people with type 1 Diabetes.  I am sure that is one reason why it is only a 24 hour pump.

 

It is interesting to think about this fact when considering the standard insulin pumps that are sometimes now prescribed for Type 2 diabetes....for 2-3 days the insulin is being deposited in the same site..........hmmmm!

 

Re: Re: New V-Go (TM) Disposable Insulin Delivery Device
Quote:

Good point, Micki

 

The amount of insulin going into that one site is far greater than the amount usually injected for people with type 1 Diabetes.  I am sure that is one reason why it is only a 24 hour pump.

 

It is interesting to think about this fact when considering the standard insulin pumps that are sometimes now prescribed for Type 2 diabetes....for 2-3 days the insulin is being deposited in the same site..........hmmmm!

I thought an average adult Total Daily Dose (TDD) of insulin is abouit 0.5-0.7 units/kg/day.   In my case that is 45-65 units/day.  My current TDD is 65 units a day as a T2, not inconsistent with a T1.  I don't find my insulin use to be "far greater," than a T1.  I would actually expect many insulin dependent T2s have an even higher TDD.  Still, my basal requirements are beyond those provided by the V-Go.

ps: Yes, I would expect a lower TDD on a pump by perhaps 20-30%, but still.

Re: New V-Go (TM) Disposable Insulin Delivery Device

I have been on the V go insulin delivery device for 41 days now. My glucose levels have been running better now than ever.

Re: New V-Go (TM) Disposable Insulin Delivery Device

My medical insurance thru work covers the V go completely.