Cardiovascular Journal of Africa: Vol 27 No 4 (July/August 2016)

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Since its Nobel prize-winning discovery in 1921, decades of research
have evolved the safety and effectiveness of the insulin molecule,
paving a way for novel insulins and bringing new hope for people
with diabetes.
In the 1950s, longer acting insulin preparations became available and that
allowed acceptable glucose control with only one or two daily injections.2
p137b However, it was not until 1982 that scientists were able to make insulin
safer, by developing the first ‘human’ insulins that more closely replicated
the natural insulin in the human body.4 p22a Through the decades, researchers
focused on developing more effective human insulins, such that the modern
age of insulin is marked by the development of man-made insulin analogues.
With greater similarity to natural human insulin, these molecules have been
modified to act faster or slower than earlier human insulins, allowing a range
of different analogues, each insulin with its own specific and predictable
onset of action, time of peak action and duration of action.5, 6 5.p219a, b,c,d, 6. p1a
Through the proper use of long-acting (basal) insulins, fast-acting
insulins and combinations of these (including pre-mix insulins), it
became possible to more closely replicate the natural production
of insulin in the body, allowing people with diabetes a greater
degree of treatment flexibility.5 p219a, p220b However, this often means a
person who is on insulin treatment needs to take several injections
throughout the day to address the body’s varying insulin needs.7 p15c
Most recently, technology has moved a step closer to the concept of an ideal
insulin regimen in that novel insulins mimic the profile of natural insulin
production more closely than conventional insulins.7 p15c Because they are
modified to have an ultra-long duration of action, timing of the dose is
flexible.7 p19a Furthermore, because of their novel chemical properties, for the
first time it is possible to combine two different insulin analogues in a single
pen device.7 p16b
Through this innovation, an ultra-long-acting insulin and a rapid-
acting insulin can be combined and administered with one injection
device, potentially reducing the number of injections that a person
would need to control their blood glucose throughout the day.7 p16b,p18b
Device updates
In tandem with these breakthroughs in the development of insulin, the
devices used to administer the insulin have also progressed. The advent of
the insulin pen has made these once-feared injections as easy as the click of
a button. First launched in 1985 by Novo Nordisk8 p505a, the world’s largest
diabetes company, insulin pens today are either durable devices (that can
be reused) with replaceable cartridges, or prefilled disposable pens. These
pens use shorter, finer and sharper needles than those of traditional syringes,
making the process of injecting oneself easy, smooth and virtually painless.8,9
8. p508 9. p12a
Insulin pens have allowed injection of insulin to become convenient and
discreet, while improving lifestyle flexibility and making it easier for people
with diabetes to adhere to their therapy. They have also removed the
potential stigma of drawing up insulin in a syringe and injecting it in a public
place.9 p12b,p15a Over the years, advances in technology have included the
development of pens that deliver smaller more accurate doses specifically
designed to suit the needs of children and adolescents. Colourful, creative,
interchangeable ’skins’ allow the devices to be personalised. In 2010, there
was a newly developed pen with a memory function that records the dose
and the time delivered, providing assurance for parents and school staff that
the correct dose was given at the right time.9 p11a
Novo Nordisk’s continued focus on innovative solutions to adequately meet
the needs of the world’s growing population of people with diabetes has now
resulted in another world-first in injector devices; aimed at improving the
convenience and safety of insulin injections. Equipped with a series of new
easy-to-use, patient-friendly safety features to ensure that the correct dose
is administered, the latest pens are disposable devices that are prefilled with
different types of insulin according to the requirements of individual users.
In addition, many of the latest features have been designed specifically to
accommodate people with visual impairment or reduced dexterity, making it
much easier for them to use an insulin pen rather than a vial and syringe.9,10
10. p523a; 9.p14b
Like any other innovation, progress in insulin development not only solves
some of the problems posed by older treatments and administration devices,
but also highlights new ones. These ’treatment gaps’ are a constant focus to
the scientists involved in making the lives of people with diabetes safer, easier
and happier. For the first time, being able to combine a true long-acting
insulin analogue with a short-acting one in the same novel administration pen
is a further encouraging step in this journey.
Both insulin and device will soon be available in South Africa.
This information is supported by Novo Nordisk – the world’s largest diabetes
company. Novo Nordisk is committed to innovation, and continues to evolve
insulin and diabetes care to improve the lives of the millions of people living
with diabetes around the world.
References
1. Aras M. Ninety years of insulin – Canada celebrates. Diabetes Voice. 2012; 57(1): 41-42.
2. Rotella CM, et al. Role of Insulin in the Type 2 Diabetes Therapy: Past, Present and Future.
International Journal Endocrinology and Metabolism. 2013; 11(3): 137-144.
3. Pettus J, et al. The past, present, and future of basal insulins. Diabetes/Metabolism Res Rev
2015. Published online. DOI: 10.1002/dmrr
4. Novo Nordisk A/S. Novo Nordisk History. Available at:
novo-nordisk/novo-nordisk-history/step-by-step.html. Accessed on 4 July 2016.
5. Ashok KD & Ashida TS. Modern Insulins – The Insulin Analogues: A Reappraisal. Medicine
Update. (n.d.) Available at:
Accessed on 4 July 2016.
6. Novo Nordisk (USA). What is Insulin? Types of Insulin (2015). Available at: https://www.
html. Accessed on 4 July 2016.
7. Unnikrishnan AG, et al. Review of clinical profile of IDegAsp. Journal of The Association of
Physicians of India. 2015; 63(Suppl): 15-20.
8. Selam JL. Evolution of Diabetes Insulin Delivery Devices. Journal of
Diabetes, Science and Technology. 2010; 4(3) 505-513.
9. Hyllested-Winge J et al. NovoPen Echo® insulin delivery device. Med
Devices: Evidence and Research (Auckl). 2016; 9: 11-18.
10. Pearson TL. Practical Aspects of Insulin Pen Devices. Journal of
Diabetes Science and Technology. 2010;4(3): 522-531.
Novo Nordisk South Africa
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