Dr. Sung-Eun Yoo, an Endocrinologist at the Cary Endocrine and Diabetes Center talks about the V-Go Patch, and how it makes it easier for patients to remember to take their insulin, with just the click of a button.
Interview conducted by Ivanhoe Broadcast News in December 2017.
When we are talking about diabetes, what are some of the most difficult things you’re finding for your patients?
Dr. Yoo: Sticking to their scheduled insulin shots throughout the day, if a patient is on a typical day of insulin injections. And if they’re on pills their compliance is easier but shots before each meal make them difficult to comply.
What is it about the shots that make it difficult for your patients or maybe less palatable?
Dr. Yoo: Forgetting to take insulin out when they go out to eat and meet friends and if they travel they have to take it in cooler and then they forget those. And just simply forget, a lot of patients just forget to take insulin. And then especially if they have to take it before each meal, at lunch time they forget and evening function they go out they don’t take insulin. So that makes their diabetes control remain difficult.
For viewers who may not be as familiar with diabetes and trying to maintain your blood sugar, why is it critical that they take their insulin? Especially when they take it before a meal?
Dr. Yoo: For a Type II diabetes patient initially they require oral therapy and there are a lot of great pills available. But after ten, fifteen years their body doesn’t make enough insulin to cope with the high blood sugar so you have to take insulin. There are two types of insulin: one is a baser insulin taken once a day but to cover a meal you have to take a meal insulin, so before breakfast, lunch and dinner. If you eat carbohydrates you need the insulin to digest carbohydrate so taking it before each meal has to be a habit. It’s hard to make each meal shot a habit.
If they’re not compliant or they’re compliant once in a while what happens?
Dr. Yoo: If they don’t take insulin, I just saw a patient who peaks right after lunch time each time because they don’t take insulin at lunch time but their breakfast and after dinner sugar is fine. But if a patient consistently misses the shots before a certain meal it raises blood sugar very high and that makes your A1C goal remain elevated.
When you have that spike, what’s the risk for the patient? Do they feel it or is it over time?
Dr. Yoo: Being tired after a meal is one of the symptoms. And over time an increase of A1C, every one percent increase over A1C increases thirty percent of the complication of the diabetes related complications.
What could they be looking at? You’re elevating your risk of some pretty serious health problems aren’t you?
Dr. Yoo: Yes, high sugar involves the small vessels where reaching small vessels your eye, kidney and your nerves. So those three organs are affected and eventually they’ll affect your heart muscles as well.
What percentage?
Dr. Yoo: For every one percent decrease of A1C decreases thirty percent of complication rates.
But the opposite is also true?
Dr. Yoo: The opposite is true.
Talk to me a little bit about the patch. What is this and what could it potentially do for some of your patients?
Dr. Yoo: The veal patch came out I think about ten years ago and when I saw it I thought it’s very convenient and it’s a patch you wear. And as I said that there’s baser insulin and then there’s meal insulin. And it just combines both functions. It delivers small amounts throughout the day so it covers baser insulin need. And then you click the button each time you eat, that covers meal insulin, so you don’t have to carry your insulin cooler and needles and you just click when you go out to eat and throughout the day. It makes treatment convenient, easy and available.
Does it feel like a little shot or a prick, how does it work?
Dr. Yoo: The catheter goes in with a small device and the patient usually don’t complain about the pain or the uncomfortable feeling.
Who is the best candidate for this veal patch?
Dr. Yoo: We usually recommend a patient with Type II diabetes who requires much of daily injections throughout the day who tend to forget the shots. If there is a compliant issue and there is a need for multiple daily injections veal can be a very good option.
Are you prescribing this more often, are you seeing more patients looking for solutions? You said it’s been around for about ten years but many patients may not be aware of it?
Dr. Yoo: There’s an insulin pump but it’s a much more complicated system. Not every patient needs the complicated system if you set a certain dose each meal then if you go every click delivers two units of insulin. So if you need a sixty then you do three clicks. It’s much easier, I’m not so sure why it’s not widely available. Its providers are probably not used to prescribing this device and so I’ve been prescribing it. In patients who stick to it they do very well. AIC drops and patients compliancy is much better with this device.
Is there any risk of them getting excited and clicking it too much and over dosing. Are there any risks to it?
Dr. Yoo: There are three different baser sets, twenty units throughout the day, thirty units, so you cannot do too many clicks with this device. A hypoglycemia risk is not that much; you just do it before each meal. Of course if you end up losing significant weight your baser rate requirement is less. You can decrease a lower baser rate patch instead of forty units you can decrease it to thirty units patch.
When you’re talking about the units how often do you have to switch the patch?
Dr. Yoo: Once a day.
First think in the morning?
Dr. Yoo: Once a day you just click before each meal, usually three times a day. And you can click it for snacks as well so that makes it easy.
That means you’re not bringing a cooler, what does it get rid of now that you have kind of a traveling compact on your arm with you?
Dr. Yoo: Nowadays insulin is not drawing from vile, it’s a pin. With an insulin pin you don’t need needles, you don’t need coolers; it’s much easier it’s on your arm and you don’t have to take anything.
How do patients respond when you tell them about it and say, look for you this may be the way to go? Can you tell me a little bit about patient feedback?
Dr. Yoo: They didn’t hear about that so they are very curious to know about the patch and we show them and most of the time patients are very positive as long as their insurance covers it. And most of the time it’s covered and it’s cheaper than their multiple daily injections because two insulin becomes one insulin and it covers better.
So most insurances do pick up that?
Dr. Yoo: Right.
Is there anything I didn’t ask you that you would want to make sure people would know about the patch?
Dr. Yoo: You could forget the click. You have to click each time, it’s not an automated system. Your part is the clicking before each meal but much easier than conventional shots. The patient has to do that part but their provider has to write the exact which twenty, thirty, forty veal and and how many clicks the patient has to do. Your provider will give a precise instruction and patient only does the click part.
How often do you follow them when they’re on the patch?
Dr. Yoo: Usually after getting patch we do have a system following that within a couple of weeks and then after that usually we do every three months follow up.
So most of your patients are able to do the switch?
Dr. Yoo: Yes, switch and then we do have a very good support system. And then they come in and the educator sits down for an hour or so and makes sure they understand it before they go. And their A1C usually improves very well. Every three months visit, they see improvement throughout the year.
You are seeing improvement in the A1C with patients?
Dr. Yoo: Right. As long as the patient does clicks.
About how much improvement?
Dr. Yoo: Good improvement is up to three percent. Some patients make one percent. It depends on how uncontrolled that they were before. A three percent is a significant improvement.
Who is prescribing it to patients?
Dr. Yoo: I was the initial provider that have known about veal. I have known this system for almost ten years. Since it came out. And recently I’ve been prescribing more.
Why is that? You see the need?
Dr. Yoo: Patients pick up better insurance coverage over the last several years. Before then it was a new device and the insurance doesn’t cover well, so there wasn’t much of a benefit of doing it. Even if patients want it and they cannot afford it you cannot prescribe it. But recently insurance coverage is better and patients with their daily injections.
END OF INTERVIEW
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